Does a standard septoplasty straighten the caudal septum? (Photo)

Question

as you can see from my cat scan, my caudal septum is crooked. I was wondering if a typical septoplasty surgery will straighten the caudal septum, or is that portion of the septum usually left untouched? any help would be greatly appreciated.

Matthew Bridges, MD, FACS · Answer

The caudal,  or front edge, of the septum is frequently deviated.  Most times this does not cause nasal obstruction but can certainly cause nostril asymmetry or deviation of the tip.  Fixing the caudal septum can be very tricky since modification of this cartilage can result in external changes.   Most standard septoplasties do not require maneuvers to address this area.   You should discuss this specifically with your surgeon.  Admitting extreme bias, I would highly recommend an ENT/facial plastic surgeon for this type of procedure.

Myriam Loyo, MD · Answer

Deflections of the caudal end of the nasal septum are often hard to address with primary septoplasty.The caudal part of the septum is the most anterior part of the septum. It is the part you can touch immediately in the front of the nose. The caudal septum is very important because it helps support the nasal tip. Caudal septal deviations can cause the nasal tip to be crooked and decrease the support of the nasal tip leading to a droopy tip. When you look at the undersurface of your nose, a causal septal deflection can make your nostrils different in shape and size. When treating a crooked septum during a septoplasty, treating the caudal septum requires understanding of the complex support of the nasal tip. During conventional septoplasty the most anterior  part  of the septum (1 cm in the front) is left intact to prevent later collapse of the nose. In cases when the caudal septum is significantly deviated, the surgeon might need to go into the most anterior part of the septum and work on that very important piece of cartilage to get it straighter. Sometimes the caudal portion of the cartilage needs to be replaced altogether with a straighter piece. I recommend you talk to your surgeon about straightening the front part of your septum (and nose!)Good luck

William Portuese, MD · Answer

Yes, a septoplasty is performed to straighten a caudal septum. There must be  nasal obstruction present in order to be qualified for medical necessity. The CAT scan shows a patent and wide open airway on both sides in addition to the  Crooked caudal septum and nose, therefore a cosmetic rhinoplasty is most likely required

Michael T. Somenek, MD · Answer

Addressing the caudal septum takes an additional level of experience because it is not frequently addressed through a standard septoplasty incision. Caution needs to be used with the caudal septum because shortening it or trimming it can lead to external changes to the nose which may be undesirable. Make sure you go to a rhinoplasty specialist who can address this issue.

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