We have read the article entitled “Simplifying the Management of Caudal Septal Deviation in Rhinoplasty” by Constantine et al. with great interest.1 The high percentage of caudal septal deviation in rhinoplasty patients and management of the problem is pointed out in this article. The authors have stated the vertical excess in the C- or S-shaped septum and the importance of excision from the caudal part of the L-strut and anterior nasal spine and maxillary crest. They suture the septum to the contralateral aspect of the nasal spine to establish the relation between these anatomical structures. This suture should be carefully adapted in both sides to prevent any altering effect on the tip projection and rotation.
We also have a high percentage of caudal septal deviation in our patients and usually need to perform caudal septal excision to eliminate the detrimental effects of vertical excess of the septum. A gap will usually occur between the L-strut and nasal spine after excision, which makes the adaptation of the aforementioned suture important. To overcome this problem, we use a sheet of polydioxanone foil (PDS plate; Ethicon, Inc., Johnson & Johnson, Inc., New Brunswick, N.J.) to recreate the straight-line relation of the caudal septum with the anterior nasal spine. The versatile and biodegradable polydioxanone plates are commonly used materials in nasal surgery, with the advantages of stabilizing septal fragments and minimizing the cosmetic and functional sequelae associated with nonabsorbable implants.2,3
To briefly describe the technique, a polydioxanone plate is prepared according to the shape of the L-strut and the nasal spine with a minimum width of 10 mm. The prepared polydioxanone plate is perforated with 16-gauge needles and placed in one side of the septum vertically, with the inferior part leaning on the anterior nasal spine. The plate is adapted to the septum and to the periosteum of the anterior nasal spine with 5-0 polydioxanone sutures (Fig. 1). This technique gives the advantage of keeping these anatomical structures in their proposed places and maintains a strong straight relation between them. In some cases where stronger tip support of the septum is needed, the foil can be prepared for both sides of the septum.
The authors have no financial interest to declare in relation to the content of this communication. No funding was received for this work.
Candemir Ceran, M.D.
Ersin Aksam, M.D.
Mustafa Erol Demirseren, M.D.
Ataturk Research and Training Center
Department of Plastic Reconstructive and Aesthetic Surgery
1. Constantine FC, Ahmad J, Geissler P, Rohrich RJ.. Simplifying the management of caudal septal deviation in rhinoplasty. Plast Reconstr Surg. 2014;134:379e–388e
2. Rimmer J, Ferguson LM, Saleh HA.. Versatile applications of the polydioxanone plate in rhinoplasty and septal surgery. Arch Facial Plast Surg. 2012;14:323–330
3. Tweedie DJ, Lo S, Rowe-Jones JM.. Reconstruction of the nasal septum using perforated and unperforated polydioxanone foil. Arch Facial Plast Surg. 2010;12:106–113
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