Caudal Septal Deviation

Surgery For Anterior Septal Dislocation in Istanbul

Where is the Caudal Septum?

The part of the nasal septum that separates the nasal cavity into two separate cavities, closest to the nostrils, is the "caudal septum" area. If you press this area from below with your index finger, you will see that there is a very hard cartilage in the middle of the nasal folds and it is connected to the anterior nasal spine (ANS) close to the teeth. 

What's the caudal septum deviation?

The caudal septum is the most important structure for the cartilage support of the nasal tip, and due to blows to the tip of the nose, the caudal septum can dislocate from the midline to the sides. In this case, as in the photo above, it is seen as a protrusion that protrudes into the nostrils, makes the nostrils asymmetrical and narrows the airway. In the patient above, the caudal septum is seen dislocated into the right nasal cavity. This condition is called caudal septum deviation, anterior septal dislocation or caudal septal dislocation. It causes both an aesthetic and cosmetic problem in these patients. Removing the caudal septum by simply excision may cause an incomplete application in the treatment and weaken the nasal tip cartilage tissue, which may cause sagging at the tip of the nose. In these patients, as seen in the photographs below above, the operation should be started with an open technique and the tip of the nose should be supported with a new, smooth cartilage graft obtained from the back of the nasal septum instead of the excised part of the caudal septum in order to reconstruct the nasal tip cartilage support.

Among the deviations of the nasal septum, the caudal or anterior nasal septum deviation, which is the closest to the nostrils, although it is not the most common type, but it may cause both cosmetic and functional problems at the nose tip. While the frequency of caudal septum was found to be 5% in a study by Dr.Guyuron et al. A study of Sedwick et al. Found that 8,7% of 2,043 patients had a caudal septum deviation (sources >> A pratical classification of septonasal deviation and an effective guide to septal surgery / Caudal septoplasty for treatment of septal deviation: aesthetic and functional correction of the nasal base). In addition to important functional problems, deviations of the anterior septum cause cosmetic problems. The first of these aesthetic problems is the alteration of the relationship between kolumella and the nostrils. In other words, this part of the septum, which should normally be located in the middle line behind the arms, is pushed out of the nasal cavity in the right or left side and the nasal tip is pushed in the opposite direction.

Even small anterior deviations can cause nasal congestion, the most common cause of the nasal cavity is the area at the entrance to the nostrils. Dr. Grymer and colleagues have shown that the amount of nasal obstruction caused by deviations from the anterior nasal septum may be much more severe than nasal congestions due to posterior deviations using acoustic rhinometry measurements (source link >> Acoustic Rhinometry: evaluation of the nasal cavity with septal deviations, before and after septoplasty). It is emphasized that patients with such deviation can benefit from erosion correction procedures much more than classical deviations and long-term patient satisfaction (source link >>Septoplasty: long term evaluation of results).

As seen in the photo above, patients with caudal septum deviation may cause asymmetry at the tip of the nose aesthetically, shape differences between the nostrils, and functionally nasal congestion and an increase in intranasal airway resistance. As seen in this photograph, after the tip of the nose is lifted slightly upwards and backwards with the help of a finger, it can be seen that the lowest part of the nasal septum, namely the caudal part, which protrudes into the nostrils, is dislocated, and the diagnosis of caudal septum deviation or anterior septal dislocation can be easily made. Reconstructing this area of ​​the nasal septum as much as possible is very important both aesthetically and functionally. In patients with caudal septum deviation, benzene is used for treatment only by surgically removing this dislocated part of the septum and terminating the procedure. Unfortunately, there are many patients whose caudal septum deviation, which occurs in patients who have undergone operations in different countries, especially in patients who have fallen on the tip of the nose or who have a history of trauma in the nasal tip region, was treated only with the closed technique and the process of removing the curved part of the septum was terminated. Normally, in the treatment of caudal septum deviation, repositioning of the dislocated part seen here in the midline or if there is a deviation that cannot be placed in the midline; It is planned to resection of this region and instead of it, a cartilage graft that supports the tip of the nose is placed in the midline, that is, behind the columella. In other words, it is most appropriate to perform both caudal septum resection and nasal tip reconstruction and reconstruction at the same time. General health insurances and private health insurances exclude nasal tip aesthetic operations. For this reason, in patients with caudal septum deviation, since the cartilage that should normally be placed at the tip of the nose is within the scope of nasal tip aesthetics, insurance companies exclude this operation and a simple procedure is performed in the form of resection of only the deviated cartilage areas. In this way, only when the cartilage area that overflows into the nostril is resected, serious support tissue loss at the tip of the nose, sagging expansion and serious deformation at the tip of the nose may occur. Correcting the caudal septum and providing the cartilage support tissue of the tip of the nose at the same time is the right application.

Treatment of caudal septum deviation

Swinging door technique

Therefore, many techniques have been used to correct the caudal deviations of the nasal septum. Dr. In 1929 Metzembaum described the technique of caudal septoplasty as the 'swinging door', and many other authors have developed different ways of correcting these aberrations. However, the existence of many different techniques tested and proven reflects the difficulty of correcting this anterior septum deviation. The most commonly used techniques for correcting the caudal deviations of the nasal septum include "swinging door" or variations since it was described by Dr.Metzembaun. With such a correction, the anterior portion of the nasal septum is not removed and the cartilage is excised by a series of cuts or weakened by cuts on the opposite side of the deviation, and then stabilized using sutures (source link >> Replacement of the lower end of the dislocated septal cartilage versus submucous resection of the dislocated end of the septal cartilage).

In patients with caudal septum deviation, there are authors who argue that correction of deviation with limited incisions made to curved cartilages will not be sufficient and that partial curves can be seen as a result of the improvement in the same way that can be considered as "cartilage memory" that occurs in cartilage later on. In patients with severe caudal septum deviation, it is thought that performing an operation in the form of open technique nasal tip aesthetics or open technique septoplasty is a more effective but larger operation (source links >> Is there objective evidence that septal surgery improves nasal airflow? / Outcomes after nasal septoplasty: results from the Nasal Obstruction Septoplasty Effectiveness (NOSE) study / Applications of the biomecanical behavior of cartilage to nasal septoplastic surgery).

Open technique tip plasty / Open technique septoplasty / Open technique caudal septoplasty 

In patients with advanced caudal septum deviation and a clear nose tip asymmetry, open technique nose tip plasty operation is appropriate. The aim of this operation is to correct both the airway narrowing caudal septum region and the removal of the asinmtrin at the tip of the nose. During the procedure, a new cartilage graft is placed in place of the resected caudal septum and the loss of support at the nose tip is prevented.

Similarly, open technique septoplasty can also be performed for the treatment of caudal septal deviation. Caudal septoplasty can be performed with open technique or closed technique. In general, I prefer an open technique that provides anatomic imperfection to perfection.



Caudal septal dislocation or anterior septal deviation is treated with caudal septal surgery. The images show the tip of the nose of a patient who underwent open technique caudal septal surgery before and after the surgery. The caudal septum region dislocated into the right nostril was resected during the surgery and the same area was supported with new cartilage grafts.

Caudal septal dislocation is treated with caudal septal septoplasty operation. The images show the tip of the nose of a patient who underwent open technique caudal septoplasty before and after the surgery. The caudal septum region dislocated into the right nostril was resected during the surgery and the same area was supported with new cartilage grafts.

 

In the above photos, the patient who had undergone open technique caudal septoplasty operation, pre-operative and post-operative nasal tip is seen.

Open Technique Caudal Septoplasty + Nose Tip Plasty Operation

In the photographs below, a patient who had previously suffered a trauma to the nose and subsequently developed a distortion of the tip of the nose and asymmetry between the nostrils, has a dilated caudal septum from the right (anterior septal dislocation) before the operation, the right nostril is small and ellipsoid in shape, and the left nostril is round and large. After the open technique caudal septoplasty + nasal tip aesthetics, the nostrils are more symmetrical and the tip of the nose is more upturned. No procedure was performed on the patient's nasal bone.

Similar links about caudal septal deviation >>

• Why Is It Necessary To Perform Open Technique Septoplasty In Some Noses? - Severe Anterior Septal Deviation
• Results of Childhood Nasal Trauma Can Occur Later Period!
• Traumatic Caudal or Anterior Nasal Septum Deviation Treatment Difficulties
• Septoplasty Operation in Istanbul

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