What's the best way to fix my caudal deviation?

Question

I want to fix my caudal deviation, however, it seems to be a difficult problem to fix per the literature. This would be a revision procedure (1st caused it or didn't fix it - not sure). I have an L strut and the deviation feels like a slight C shape. One method mentioned was removal of the nasal crest and relocation of the septum on the other side of the nasal spine. Is this recommended and/or safe? Another method was the tongue in groove. Not sure that I have sufficient columella for this.

John Frodel, MD · Answer

While I'm uncertain of the cause of your columellar deviation, it appears that either the end of the septum or a graft at the end of the septum is bulging into the right nostril, and this is the likely cause of the deformity.  The methods you mention are all considered and may all be used at once.  Please consult with an experienced revision rhinoplasty surgery and they can evaluate these issues for you.  Good luck.

Jarrod Little, MD · Answer

Caudal septal deviations are very difficult to correct.  If the cartilage is simply dislocated off of the maxillary crest, it may be repositioned.  However, many of these problems involve cartilage that is dislocated AND warped.  The correction of the warped aspect of the cartilage is where the difficulty lies.  Correction may involve cartilage grafting or the use of synthetic grafts (PDS plate) to straighten the caudal strut.  It would be important to personally consult with a board-certified Plastic Surgeon who has a particular interest in Rhinoplasty.

Robert S. Schmidt, MD · Answer

Caudal septal deviations are much easier to fix in primary surgery than revision, simply because the amount of available cartilage limits what you can do. For primaries, I have grown to favor a caudal septal replacement graft- excising the base of the septum up to a straight portion, then make a big replacement graft and secure it to the nasal spine and remaining dorsal septum, with spreader grafts to stabilize it. In your case, some combination of judicious excision and a wright stitch would help. Tongue in groove I don't think would help and in fact would make your nasal tip deviated too- the septal cartilage is stronger than the cartilage of your medial crura, so it wins. You could still have a replacement graft, but likely you'd need rib cartilage. This is tricky. Be sure to visit with someone who's experienced with revisions.

What's the best way to fix my caudal deviation?

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What's the best way to fix my caudal deviation?

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Everything you need to know about Revision Rhinoplasty

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