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Simplifying the Management of Caudal Septal Deviation in Rhinoplasty

Constantine, Fadi C. M.D.; Ahmad, Jamil M.D.; Geissler, Palmyra M.D.; Rohrich, Rod J. M.D.

Plastic and Reconstructive Surgery: September 2014 - Volume 134 - Issue 3 - p 379e–388e
doi: 10.1097/PRS.0000000000000236
Cosmetic: Special Topic

Summary: Correction of the deviated nose poses a challenge in even the most experienced hands. Frequently, the surgeon is faced with both a functional (airway obstruction) and an aesthetic problem that must be addressed conjointly. Accurate preoperative analysis and intraoperative diagnosis are integral to good outcomes. Caudal septal deviation is frequently present in patients presenting for rhinoplasty. The authors’ current graduated technique for simplifying the management of the caudally deviated septum both aesthetically and functionally is described. If there is a persistent caudal septal deviation that has not been addressed by standard maneuvers, the caudal portion of the anterior septum is resected at the osseocartilaginous junction with the anterior nasal spine and maxillary crest and then sutured back to the periosteum of the anterior nasal spine with 5-0 polydioxanone. We have found this to be a safe and effective way of addressing the caudally deviated septum in the majority of cases.

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Dallas, Texas; and Mississauga, Ontario, Canada

From the Department of Plastic Surgery, The University of Texas Southwestern Medical Center; and The Plastic Surgery Clinic.

Received for publication July 16, 2013; accepted December 12, 2013.

Disclosure: Dr. Rohrich receives book royalties from Quality Medical Publishing and instrument royalties from Micrins. The other authors have no financial interest to declare in relation to the content of this article.

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Rod J. Rohrich, M.D., Department of Plastic Surgery, The University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, Texas 75390-9132,

©2014American Society of Plastic Surgeons