We Performed Revision Open Technique Caudal Septoplasty + Nasal Valve Surgery

Revision Caudal Septum Correction Surgery With Nasal Valve Operation

The part of the nasal septum closest to the nostrils (caudal septum) is an important part of the nasal cartilage support. At the same time, deviations that may occur in this region (caudal septum deviation - anterior septal dislocation - caudal septal dislocation) may cause both aesthetic and functional problems at the tip of the nose. A patient who developed caudal septum deviation, nasal obstruction, and collapse of the nasal wings following a childhood-wide nasal trauma, applied to our clinic after the closed technique septoplasty operation performed in another clinic 4 years ago, and her complaints did not change and nasal tip sagging occurred. In the examination of the patient, dislocated caudal septum and irregular areas of nasal septum deviation that completely obstructed the right nostril due to previous incomplete resection were detected (green arrows in the photo above). In fact, many things can be understood from this photograph. Only partial resection of the part of the caudal septum, which should sit in the bone notch on the tip of the nose, just behind the columella and on the anterior of the crista maxillaris, and the further weakening of the nasal tip cartilage support may cause an increase in the deformation at the tip of the nose and may mean that the patient is operated unnecessarily. In patients with caudal septum dislocation, it is necessary to place the caudal septum in its normal midline position with the swinging door technique or to correct the deviation of the caudl septum with the open technique, and to re-create cartilage support to the columella. Preoperative photographs of the patient also showed alar collapse and nasal valve stenosis (red arrows above and in the photo below). A bilateral spreader graft, alar batten graft, bilateral marginal rim graft were placed in order to widen the nasal valve angle of the patient and reduce nasal airway resistance, and a columellar strut graft was placed to increase the nasal tip support (yellow arrows in the photo above). In particular, careful evaluation of patients with caudal septum deviation and reshaping of the nasal cartilage structure is very important. Partial caudal septum resections using the closed technique may cause complicated revision nasal tip operations in these patients. In some patients, since there is not enough cartilage tissue, it may be necessary to use the patient's own auricle cartilage, the patient's rib cartilage or other human cadaver rib cartilage. Since the patient I shared with you here did not want too much change regarding the shape of the nose, a surgical procedure was performed only on the tip of the nose and especially for functional purposes. However, a straightening at the tip of the nose and a more symmetrical appearance at the tip of the nose were obtained.