Can any doctors who are experts on caudal septal deviation share their possible approaches for this problem?

The septal cartilage can be scored and straightened with a spreader graft for support. If too long it can be trimmed but usually suturing the medial crura to the septum can be enough to shorten ptotic tip.

The caudal septum, the part nearest the skin in between the nostrils, can curve in a number of planes and has a direct effect on the overlying tip cartilages and nostril apertures. Looking back at any subject will usually find conflicting information, because as time goes on we have a better understanding of the physical world around us, including the fields of medicine and surgery. A perfect example is cartilage 'memory', which hounded early surgeons relying on destructive techniques to straighten cartilage. Today, an open approach allows precision excision of non-structural septal cartilage and placement of permanent structural cartilaginous grafts to get predictable and durable septal straightening. BTW, there is no such thing as a 'caudal septal deviation' specialist.

Many surgeons try to straighten a deviated caudal septum using a variety of methods. I just cut out the lower portion of cartilage usually about 3 millimeters. Has worked every time and it’s simple. Surgeons stopped doing it that way when they converted over to open rhinoplasty.

It is a common problem. IMHO the easiest way is to use a hemitransfixion incision (only on one side) then isolate the deviated caudal septum. It is then cut. A pocket is made in the midline between the medial crura and it is placed in that spot in exact midline and held with through and through absorbable sutures. Has worked well for my patients.
Regards
Dr. J

Hi Beautyqueen2023,
Thanks for your question. Caudal septal issues are among the most challenging that a rhinoplasty surgeon has to deal with. The reason being that there are a variety of reasons someone might have problems with their caudal septum (eg. intrinsically weak cartilage, overgrown cartilage, prior surgery resulting in distortion of the caudal septum, etc.). This is the main reason that you see so many different potential treatment options regarding the caudal septum. In my practice, I employ a variety of techniques (eg. caudal septal replacement grafts, caudal septal splinting, caudal septal resection and reconstruction) depending on the needs of the patient. The most important thing is that your surgeon uses an appropriate technique based on your anatomy in order to achieve the functional and aesthetic outcomes that you are looking for.

Good morning. I repair quite a few caudal septal deviations. There is no "one solution fits all." I do find that if the caudal septum is deviated, it is frequently NOT addressed with a standard septoplasty, and at least for me, an open approach tends to be the most successful. I have not had luck trying to score, or convince the cartilage (which has memory) to be straight, so I have a low threshold to remove the caudal septum and replace it, typically with rib cartilage. By no means is this the only way/approach, this is just the technique that works the best for me.

The deviated caudal septum. deviation of the caudal septum is very common, and depending on the plane in which it is deviated can be the easiest to repair. Repairing deviation of a caudal septum in the horizontal plane may involve removing a piece of septum behind the caudal septum, repositioning the caudal septum after freeing it up in the midline, fixing it in the midline with suture material, and adding grafts to help straighten the curvature, and making small scratches on the concave side to weaken it, straighten it and help prevent recurrence. Usually a combination of these procedures are performed depending on how badly deviated the caudal septum is. But a combination of a submucous resection, Removal of the base of the caudal septum freeing it up, attaching it in the midline, scratching or “scoring“ the concave side, and applying a Cartlidge graft is a very powerful and usually very successful way of dealing with a caudal septal deviation in the horizontal plane. cartilage does have some memory and there is always a small possibility of residual crookedness or recurrence of some crookedness but using the above techniques the improvement is very significant and lasting, And any residual or recurring crookedness is usually very minimal.