Institutional members access full text with Ovid®

Share this article on:

Surgical management of the distorted caudal septum

Palma, Pietroa; Khodaei, Imanb

Current Opinion in Otolaryngology & Head and Neck Surgery: February 2014 - Volume 22 - Issue 1 - p 52–57
doi: 10.1097/MOO.0000000000000019
NOSE AND PARANASAL SINUSES: Edited by Samuel S. Becker and Nithin D. Adappa
Watch Video

Purpose of review This article reviews the current trends in the surgical approach to the caudal septum, and its importance in rhinoplasty. The evolution of rhinoplasty techniques over the past half century has changed the emphasis from excessive cartilage resection, and a plethora of grafts and sutures, to a more conservative approach that seeks to maintain the function of the nose and create a naturally beautiful, ‘not-operated’ look.

Recent findings New anatomical studies continue to shed light on the importance of soft-tissue support, and the mechanical properties of the caudal septum. When applied to surgical techniques, these new findings emphasize the principles of adequate preoperative history and examination, nasendoscopy, and facial analysis. On the basis of these clinical findings, a unique, tailor-made rhinoplasty game plan can be created for each patient that should not be used for another operation. Several techniques have emerged from the natural evolution of rhinoplasty that produce controlled, reversible effects in a predictable, stepwise manner.

Summary The caudal septum plays a key role in nasal airflow, provides support for the nasal tip, and affects the alar–columellar relationship. Deviation at the caudal septum creates some of the commonest problems in aesthetic rhinoplasty.

Through new anatomical knowledge and advances in rhinoplasty techniques, the vast majority of these problems can be approached through an endonasal/hybrid rhinoplasty approach. Hybrid rhinoplasty refers to a distillation of best of both worlds of external and endonasal surgery over the past 40 years.

The key to a successful outcome relies on adequate clinical examination, nasendoscopy, detailed surgical facial analysis, and a well planned surgical game plan.

Video Abstract SDC 1 (

Supplemental Digital Content is available in the text

aDepartment of Otorhinolaringology Head & Neck Surgery, University Hospital, Varese, Italy

bMehregan Clinic, Karaj, Iran

Correspondence to Pietro Palma, Clinical Professor, Department of Otorhinolaringology Head & Neck Surgery Via Volta, 7A–20121 Milan, Italy. Tel: +39 03355250472; fax: +39 026575516; e-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins