Caudal Septal Deviation Research Articles

Anterior Nasal Spine Relocation for Caudal Septal Deviation: A Case Series and Discussion of Common Scenarios.

Deviation of the anterior nasal spine (ANS) is a common cause of caudal nasal septal deviation. In our experience, relocation of the deviated ANS is a useful technique in the correction of the caudal septal deviation. To describe our experience with the ANS relocation technique in isolation and in combination with other techniques for correction of caudal septal deviation. A retrospective chart review was performed on cases of ANS relocation. A total of 378 patients underwent ANS relocation over 4years. Complete straightening of the septum occurred in 312 cases (82.5%), and significant improvement with mild remnant deviation occurred in 66 cases (17.5%). No patients had severe remnant deviation. None of the patients requested for revision surgery. A total of 351 patients (92.9%) experienced significant subjective improvement in bilateral nasal airflow, while 27 patients (7.1%) experienced mild improvement in bilateral nasal airflow. None of the patients had worsened airflow after surgery. The ANS relocation technique is a useful and effective technique which can be used in isolation or in combination of other techniques for the correction of caudal septal deviation. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Different techniques for caudal extension graft placement in rhinoplasty

IntroductionThe caudal extension graft is usually a cartilage graft that overlaps the caudal margin of the nasal septum. A combination of the caudal extension graft and the tongue-in-groove technique is used to stabilize the nasal base, set tip projection, and refine the alar-columellar relationship. ObjectivesIn this study we present some new modifications to the placement of caudal extension grafts in rhinoplasty. MethodsThis study is a retrospective review of a prospectively collected database of 965 patients who underwent septorhinoplasty from June 2011 to July 2015. Of these, 457 patients required a caudal extension graft and were included in the study. Minimum follow-up was 13.2 months with a mean follow-up time of 17.4 months. ResultsIn most cases, comparison of photographs before and after surgery were satisfactory and showed improved contour. Minor deformity was detected in 41 patients and 11 patients needed revision surgery. ConclusionWith these modifications the surgeon can employ the caudal extension graft even in angulated caudal septal deviations. A variety of methods have been proposed for correction of caudal nasal deviation.

Orientation of the premaxilla in the origin of septal deviation.

While most people believe the nasal septum to have intrinsic deviation and overgrowth in patients seeking rhinoplasty, an alternative concept is that a mal-oriented premaxilla causes extrinsic septal buckling and external extrusion of the septal cartilage. In this sense, the premaxillary bone plays a significant role in the pathogenesis of septal deviation. This study was performed to determine if non-traumatically acquired septal/nasal functional and aesthetic pathology or septal deviation may be related to the orientation of the premaxilla relative to the skullbase. A retrospective, single-center study of patients in the general population who underwent maxillofacial CT scans and presented for the evaluation of nasal obstruction. CT scans were used to measure features of both pathologic and non-pathologic nasal septums. A total of 68 subjects were evaluated. When comparing patients with a premaxillary-skullbase angle of greater than 81° (the mean of the study group) to those of less than 81°, and a more obtuse nasolabial angle was observed (p = 0.0269). When comparing the extremes of premaxillary rotation, specifically, greater than 87° (mean 91.7°, SD 5.1) and less than 77° (mean 70.7°, SD 3.6), the differences were more pronounced with regard to caudal septal excess (p = 0.0451) and septal deviation in the axial plane (p = 0.0150). Septal developmental changes may involve an overly rotated or more vertically oriented premaxillary bone relative to the skull base. An understanding of the cause of septal deformity may provide insight into the design of improved treatments.

Caudal Septal Division and Interposition Batten Graft: A Novel Technique to Correct Caudal Septal Deviation in Septoplasty.

Correction of caudal septal deviation is a challenging task that may require multiple surgical approaches. To introduce a novel technique - caudal septal division and interposition batten graft - and evaluate its surgical outcomes in patients undergoing correction of caudal septal deviation. The surgical procedure includes a division of the deviated caudal L-strut preserved after resection of the deviated quadrangular septal cartilage at the central portion. A batten graft made of septal cartilage or bone is interposed between the cut ends of the caudal L-strut, the upper part of which mobilized toward the more concave side of the nasal cavity, and then sutured. The medical records of 29 patients with caudal septal deviation who underwent septoplasty using caudal L-strut division and interposition batten graft technique between January 2016 and March 2018 were retrospectively reviewed. Patient satisfaction and symptom improvement were evaluated by using the Nasal Obstruction Symptoms Evaluation scores. Endoscopic assessment of deviation correction was performed and postoperative complications were analyzed. Of the 29 patients, 19 (65.5%) answered the telephonic interview. Mean Nasal Obstruction Symptoms Evaluation scores were 62.1 preoperatively and 9.2 postoperatively, exhibiting significant improvement (P < .001). Satisfaction was rated as much improved in 9 (32.0%) patients, improved in 16 (57.0%), unchanged in 2 (7%), and worse in 1 (4%). Records of endoscopic examinations showed that 26 (82.9%) patients had a straight septum, 4 (11.4%) had improved but persisting caudal deviation, and 2 (5.7%) had no available data. Four patients had postoperative complications: 2 had septal abscesses, 1 had wound dehiscence, and 1 had synechia. All of these complications were managed without persistent problems. Caudal septal division and interposition batten graft can serve as an alternative surgical approach with acceptable surgical outcomes for managing severely deviated caudal septum. 4.

Partial Cutting and Suture Technique for Caudal Septoplasty.

Background The partial cutting and suture technique is a modification of the cutting and suture technique that overcomes the limitations and simplifies the procedure of the cutting and suture technique. Objective We describe the partial cutting and suture technique and evaluate its effectiveness of correcting caudal septal deviation. Methods We retrospectively reviewed the medical records of patients who underwent anterior septoplasty using the partial cutting and suture technique. The patients were evaluated with the Nasal Obstructive Symptoms Evaluation (NOSE) scale scores and the acoustic rhinometry preoperatively and 3 months postoperatively. Results Thirty-one patients underwent caudal septoplasty by our novel technique. The NOSE scale score changed from 43.5 to 11.0 ( P = .000). The minimal cross-sectional area (MCA) on the convex side changed from 0.49 cm2 to 0.65 cm2 ( P = .006). Conclusion The partial cutting and suture technique is relatively easy and is very effective in correcting caudal septal deviation without any complications.

The Use of Bony Septum as an Extended Spreader Graft in Primary and Secondary Rhinoplasty

Objective: To describe a surgical technique using bony septum, specifically vomer or perpendicular plate of the ethmoid (PPE), as an extended spreader graft (ESG) for securing septal extension graft (SEG) and for correcting internal nasal valve dysfunction.&#x0D; Methods:&#x0D; Design: Descriptive Case Series&#x0D; Setting: Tertiary Private Hospital&#x0D; Participants: Thirty-two (32) patients who underwent aesthetic rhinoplasty from May 2016 to October 2017 were evaluated, and ten (10) patients presenting with symptomatic obstruction were considered for inclusion. The surgical technique was applied in patients with weak SEG for control of nasal length and tip projection who had inadequate septal cartilage for SEG and ESG intraoperatively. Results were evaluated grossly under direct vision intra-operatively and post-operatively to check the patency of the internal valve.&#x0D; Results: Bony septum was used as an ESG in five (5) patients (1 male, 4 females, ages 35 to 50-years-old) with inadequate septal cartilage. Intraoperative evaluation under direct vision showed anterior caudal septal deviation in all 5 patients in whom correction was confirmed after placement of SEG and ESG. Immediate post-operative evaluation confirmed bilaterally patent nasal valve in all 5, who reported subjectively improved breathing at 2 and 4 weeks post-operatively. Post-operative photographs showed improvement of nasal length and tip.&#x0D; Conclusion: The use of the bony septum (vomer and PPE) as an ESG for primary or secondary rhinoplasty is a potentially effective means of supporting and securing the SEG for control of nasal length, preventing tip deviation or rotation and for improving internal valve function. Further trials are needed to establish its reliability and long-term effectivity.&#x0D; Keywords: rhinoplasty; vomer; perpendicular plate of the ethmoid (PPE)

Use of a crossing suture to correct caudal septal deviations.

Septoplasty usefully treats patients with nasal obstructions caused by septal deviations. However, correction of a caudal septal deviation remains surgically challenging; no standard procedure is available, although various procedures have been introduced. In this work we propose a simple, safe, and time-saving technique for patients with caudal septal deviations. The medical records of 50 patients with caudal septal deviations who underwent septoplasty using a crossing-suture technique from October 2016 to October 2018 were retrospectively reviewed. Postoperative nasal obstruction status and patient satisfaction with their surgical outcomes were subjectively evaluated using the Nasal Obstruction Symptom Evaluation (NOSE) score and telephone interview, respectively. Pre- and postoperative endoscopic findings were evaluated and postoperative complications developing during follow-up were recorded. The NOSE scores of all patients improved after septoplasty. The mean score fell from 13.46 to 3.97, and this change was significant (p < 0.0001). No complication related to use of the crossing suture was encountered. The crossing-suture technique is a simple, safe, and useful surgical option for correction of caudal septal deviations.

A new “J septoplasty” technique for correction of mild caudal septal deviation

ObjectiveA major drawback of the Killian incision is its inability to access the caudal septum and correct caudal septal deviation. Open and hemitransfixion septorhinoplasty are considered necessary in such cases. We developed a new septoplasty method that can be successfully applied in patients with mild caudal septal deviation. In this study, we evaluated the outcome of this technique. MethodsWe prospectively collected data of 16 patients with mild caudal septal deviation who underwent endoscopic septoplasty between November 2015 and October 2017. A modified Killian incision was made on the concave side of the septum. The central part of the cartilage was preserved, and excess cartilage was resected; the central part of the cartilage was sutured to the caudal cartilage. ResultsPostoperatively, the ratio of the area of the convex side to that of the concave side in the anterior portion of the nasal cavity was significantly improved, as revealed on CT analysis (p < 0.001). Nasal obstruction was significantly reduced or eliminated in all patients (p < 0.001). ConclusionThe J septoplasty method for the correction of mild caudal septal deviation is easy to perform through a modified Killian incision, and seems to be useful in selected cases.

Metzenbaum’s procedure: a forgotten technique in septal surgery

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Deviation of the caudal end of the nasal septum is one of the significant challenges encountered in septal surgery. Deviated caudal septum changes lobular and columellar relationships and has a significant effect on tip position and symmetry. Metzenbaum was the first to describe the technique for the mobilisation of the caudal end in a swinging door fashion. Our study aims to highlight the procedure and its advantages.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective study was conducted in Department of ENT and Head and Neck Surgery, Adichuchanagiri Institute of Medical Sciences, BG Nagara, between January 2018 to January 2019. 30 patients above 18 years of age, presenting with isolated deviation of the caudal end of the nasal septum were included in the study. A detailed clinical and photodocumentation was done and the results were analysed as follows. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The postoperative surgical results were evaluated using a 4 point scale. 26 (86.7%) patients gave a score of 1 on the 4 point scale suggesting that they were completely satisfied with the results. Whereas 3 (10%) patients gave a score of 2 on our 4 pt scale. 1 (3.3%) patient felt that there was only a minimal improvement after the surgery hence gave a score of 3 on the 4 point scale.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; We conclude that Metzenbaum’s technique is very effective in treating caudal septal deviations. Reviving the Metzenbaum’s procedure will help reduce the failure rate in surgeries for correction of caudal septal deviation.&lt;/p&gt;

Risk factors for intraoperative saddle nose deformity in septoplasty patients.

Septoplasty is one of the most common otolaryngologic procedures. Previous studies have reported that the overall rate of significant change in cosmetic appearance of the nose after septoplasty ranged from 0.4 to 3.4%, and saddle nose was the most commonly cited deformity. In this study, we evaluated the risk factors for intraoperative saddle nose in a group of septoplasty patients. This case-control study (1:2 case:control) was conducted based on retrospective chart review. Intraoperative saddle nose was observed in 108 (5.1%) of 2106 patients who underwent septoplasty in our center between January 2008 and December 2017. The control group consisted of 216 randomly selected, hospital-matched septoplasty patients who had no intraoperative saddle nose deformity in the same period. The demographic data, preoperative endoscopic findings, and surgical procedures of the two groups were analyzed to identify possible risk factors of intraoperative saddle nose deformity. The mean ages of the two groups were 34.8years (saddle group) and 33.2years (control group). In multivariate logistic regression analysis, clinical risk factors associated with intraoperative saddle nose were female gender (OR 3.39; 95% CI 1.76-6.54; p < 0.01), severe caudal septal deviation (OR 2.22; 95% CI 1.30-3.79; p = 0.003), and intraoperative finding of septal cartilage fracture (OR 3.96; 95% CI 1.92-8.19; p < 0.01). Severe caudal septal deviation, intraoperative fracture of septal cartilage, and female gender were risk factors for intraoperative saddle nose deformity in our study population.

Clinical Application of 3-Dimensional Printing Technology for Patients With Nasal Septal Deformities

Studies have shown the controllability and porosity of polycaprolactone as well as the use of 3-dimensional (3-D) printing for nasal reconstruction in animal models. The utility of polycaprolactone with 3-D technology in nasal cartilaginous framework reconstruction in humans remains unknown. To investigate the safety and efficacy of 3-D printed, bioresorbable polycaprolactone nasal implants. This multicenter clinical trial comprised 20 patients with caudal septal deviations who underwent septoplasty, which used a 3-D printed polycaprolactone mesh, at 2 centers in South Korea. Patients were included if they were aged 18 to 74 years and had nasal septal deviations, Nasal Obstruction Symptom Evaluation scores greater than 20, and persistent nasal obstructions. Twenty-two patients met the inclusion criteria, but 2 patients were excluded before the operation. The study was conducted from July 1, 2016, to June 30, 2017. The change in total Nasal Obstruction Symptom Evaluation score between the preoperative examination and the week 12 postoperative examination was the primary outcome. Changes in bilateral nasal cavity minimum cross-sectional area and volume on acoustic rhinometry at weeks 4 and 12 after the operation as well as changes in the nasal cavity cross-sectional area at the osteomeatal unit and nasal septum angle in the paranasal sinus on computed tomography after week 12 were among the secondary outcomes. Of the 20 patients included in the study, 4 (20%) were female, 16 (80%) were male, with a mean (SD) age of 34.95 (11.96) years. The preoperative and week 12 postoperative results revealed significant changes in the minimal cross-sectional areas on acoustic rhinometry (0.41 [SD, 0.39] vs -0.11 [SD, 0.18]; difference, 0.42; 95% CI, 0.23-0.61), nasal septum angles on computed tomography (11.22 [SD, 6.57] vs 2.89 [SD, 3.12]; difference, 8.33; 95% CI, 5.08-11.58), and Nasal Obstruction Symptom Evaluation scores (73.50 [SD, 19.88] vs 3.75 [SD, 6.26]; difference, 69.75; 95% CI, 59.22-80.28). The surgeons' convenience level with the procedure was favorable (visual analog scale score [SD], 90.90 [9.45]), and so were the patients' symptom improvements and satisfaction after 12 weeks (visual analog scale score [SD], 88.30 [9.87]). The 3-D printed, homogeneous, composite, microporous polycaprolactone nasal implant demonstrated proper mechanical support and thinness with excellent biocompatibility and surgical manipulability. Polycaprolactone may be a clinically biocompatible material for use in various craniofacial reconstructions in the future.

Use of Irradiated Homologous Costal Cartilage in Rhinoplasty: Complications in Relation to Graft Location.

Nasal septal cartilage and conchal cartilages are preferred sources of grafts in augmentation rhinoplasty. Rib cartilage can also be used, but it may evoke a patient's concerns about a scar and an extensive surgery. In such cases, irradiated homologous costal cartilage (IHCC) can be a useful alternative. However, controversy still exists in many literatures regarding complications with use of IHCC. Therefore, the authors reviewed our experiences with IHCC in rhinoplasty and analyzed the complications in relation to graft location. A retrospective chart review was made of all patients who underwent rhinoplasty with IHCC between 2007 and 2015. A total of 323 patients were included. The authors considered the cases that required revision surgery for external aesthetic changes as complications. The authors defined major complications, including resorption, infection, fracture, or warping. The total complication rate was 8%. Two fractures (0.6%), 4 fragmentation (1.2%), 4 resorptions (1.2%), 4 infections (1.2%), and 2 warpings (0.6%) were noted. Most of these complications occurred for the septal extension graft. Other complications, including 1 nasal obstruction, 2 visible contours, 3 caudal septal deviations, and 4 cases of unfavorable results (patient unsatisfactions), were noted. Based on the outcomes of this study, the authors concluded that IHCC is a useful and reliable source of cartilage graft and can serve as an alternative graft material for rhinoplasty. However, care must be taken in use of IHCC graft in areas under tension such as septal extension graft, though its complication rate is low.

Functional septorhinoplasty in the pediatric and adolescent patient

ObjectivesTo describe pediatric and adolescent patients undergoing functional septorhinoplasty and to analyze both subjective and objective outcomes. MethodsRetrospective review of prospective cohort study of patients ≤18 years old undergoing functional septorhinoplasty between 2013 and 2016 at a tertiary care center. Patient demographics, nasal exam, procedure, and pre- and postoperative nasal obstruction symptom evaluation (NOSE) score, EuroQOL 5-dimension (EQ5D), and peak nasal inspiratory flow (PNIF) scores were analyzed. Results39 patients, 48.7% male, mean age 15.9 years (range 7–18), with nasal obstruction underwent functional septorhinoplasty with mean follow up of 8.5 months. Patients reported a history of allergies (46.5%), nasal fracture (59.0%), and previous nasal surgery (25.6%). Most common exam findings included internal nasal valve narrowing (92.3%), superior/dorsal septal deviation (74.4%), external nasal valve narrowing (43.6%), caudal septal deviation (35.9%), and a narrow middle vault (33.3%). Septal cartilage grafts were placed in 79.5% of patients and PDS plate was used in 28.2%. Most common procedures included spreader grafts (84.6%), columellar strut graft (30.8%), and swinging door (23.1%). Of patients with both baseline and postoperative scores, at last follow up NOSE scores (SD) decreased from 59.0 (23.7) to 21.2 (8.8) (n = 26, p < 0.001), EQ5D VAS scores increased from 76.2 (17.7) to 85.8 (13.5), (n = 19, p = 0.056), and PNIF scores increased from 66.2 (25.3) to 90.8 (46) L/min, (n = 13, p < 0.01); all mean differences met the minimal clinically important difference for each score. 2 patients underwent revision surgery and there was one complication of a nasal abscess. ConclusionsFunctional septorhinoplasty is safe and effective in select pediatric and adolescent patients with significant nasal obstruction and results in significant improvements in both subjective and objective outcomes measures.

Transcutaneous Columellar Strut for Correcting Caudal Nasal Septal Deviation

Correction of caudal septal deviation is a challenging issue because of its significant role in tip support mechanisms. Some interventions especially aggressive resection of caudal septum to correct deviation, may compromise external nasal valve, tip ptosis and persistence of nasal obstruction. Many surgical techniques have been suggested to correct this type of nasal septal deviation. This study presents a technique to correct caudal septal deviation without weakening of tip support mechanisms. To evaluate the efficacy of insertion of a transcutaneous columellar strut during correction of caudal septal deviation. The study was performed in patients complaining from nasal obstruction with caudal septal deviation. After intranasal incision and elevation of mucoperichondrial flap, Caudal septum released from anterior nasal spine (ANS) and a band of cartilage removed from inferior and caudal part of septum and septum again fixed to ANS. Through a vertical transcutaneous incision, a cartilaginous strut is placed in columella, between medial crurae. Preoperative and postoperative NOSE score determined and photographs were taken. In 14 patients we performed this technique, the postoperative NOSE score showed significant improvement, (p = 0.001). Nasal breathing improved in all patients without any complication or tip ptosis or worsening of nasal appearance. This septoplasty technique along with placement of transcolumellar strut, is an easy, efficient and complication free method for simultaneously correction of caudal deviation of nasal septum, reinforcing external nasal valve and prevents tip ptosis.

Plastic Surgery Principles in Septorhinoplasty—Importance of the Caudal Septum in the Treatment of Caudal Septal Deviation—

Plastic Surgery Principles in Septorhinoplasty—Importance of the Caudal Septum in the Treatment of Caudal Septal Deviation—

Surgical Outcomes of Bony Batten Grafting to Correct Caudal Septal Deviation in Septoplasty.

Correction of caudal septal deviation with a batten graft has been popularized recently. However, few reports have documented the surgical outcomes of this technique, especially the use of bony batten grafts in septoplasty. To evaluate the surgical outcomes of bony batten grafting for the management of caudal septal deviation in endonasal septoplasty. This retrospective cohort study evaluates the medical records of 141 patients with caudal septal deviation who underwent septoplasty using bony batten grafts from September 1, 2011, through February 29, 2016, at a tertiary referral hospital. Patients were divided into primary and secondary surgery groups. Patients were also divided into the septoplasty plus turbinate surgery and the septoplasty only group. Endoscopic assessment of deviation correction was performed, and postoperative complications were analyzed. Patient satisfaction and symptom improvement were evaluated via telephone interviews by using the Nasal Obstruction Symptoms Evaluation (NOSE) scores. Of the 141 patients (24 women [17%] and 117 men [83%]; mean [SD] age, 32.8 [12.9] years), 86 (61%) rated their symptoms in the postoperative survey as much improved; 50 (35.5%), improved; 4 (2.8%), no change; and 1 (0.7%), worse. All patients had significantly improved mean (SD) postoperative NOSE scores (28.7 [22.0]; 95% CI, 25.0-32.4) compared with preoperative scores (70.5 [26.7]; 95% CI, 66.0-75.0; P < .001). No significant intergroup differences were observed in surgical outcome between the 116 patients undergoing primary surgery (mean [SD] NOSE score, 28.2 [21.9]) and 25 undergoing secondary surgery (mean [SD] NOSE score, 30.8 [24.3]; P = .34). No significant difference in surgical outcome was found between the 102 patients in the turbinate surgery group (mean [SD] NOSE score, 28.1 [20.8]) and 39 in the septoplasty only group (mean [SD] NOSE score, 30.4 [23.7]; P = .65). On endoscopic examination for surgical outcome, 128 patients (90.8%) had a straight septum and 13 (9.2%) had improved but residual caudal deviation. Postoperative complications included septal hematoma in 4 patients, hyposmia in 2, and chondritis in 1; all patients were treated successfully. Four patients required revision surgery because of incomplete functional correction or a desire for rhinoplasty. Septoplasty using bony batten grafts is useful for correcting caudal septal deviation with favorable surgical outcomes and an acceptable complication rate. 3.

Traction suture modification to tongue-in-groove caudal septoplasty

Caudal septal deviation leads to unfavorable esthetic as well as functional effects on the nasal airway. A modification to the tongue-in-groove (TIG) technique to correct these caudal septal deformities is described. With placement of a temporary suspension suture to the caudal septum, manual traction is applied, assuring that the caudal septum remains in the midline position while it is being secured with multiple through-and-through, trans-columellar and trans-septal sutures. From 2003 to 2016, 148 patients underwent endonasal septoplasty using this modified technique, with excellent functional and cosmetic outcomes and a revision rate of 1.4%. This modified TIG technique replaces the periosteal suture that secures the caudal septum to the midline nasal crest in the original TIG technique. This simplifies the procedure and minimizes the risk of securing the caudal septum off-midline when used in endonasal septoplasty.

Caudal Septoplasty for Treatment of C-Shaped Craniocaudal Deviation Using Synthetic Struts

We describe our technique using polydioxanone (PDS) foil for the correction and stabilization of caudal septal deviation. In addition, we evaluate the effectiveness of this technique in the treatment of the C-shaped craniocaudal sepal deviation. A retrospective review was conducted of 55 patients who underwent open septorhinoplasty with PDS splinting for the correction of a caudal septal deviation. The mean age was 35 years (range, 25-45 years), 38 of 55 (69%) were females and all had symptomatic nasal obstruction. Preoperatively, there were osteocartilaginous involvement and hypertrophy of the inferior turbinate at the opposite side of the septal deviation in all cases; whereas 30 (54.5%) patients had a bone spur, 20 (36.3%) had collapse of the external nasal valve due to septal deviation. Five patients complained of sinus headache that resolved after surgical correction. All patients were pleased with their functional improvement and 52 (95%) with their aesthetic results. Only 1 patient required surgical revision, which was due to the development of asymptomatic posterior septal perforation identified at follow-up endoscopy. There were no additional postoperative complications. Splinting of the septal cartilage with a PDS foil was feasible, safe, and effective for the treatment of severe caudal septal deviation. This technique emerges as an alternative to traditional cartilage grafting, especially in patients with insufficient cartilage for harvest or in patients with thin nasal dorsum in whom the use of a spreader graft can widen the nose and modify the normal nose contours, providing long-term support and stability of the septum.

Repair of caudal septal deviation: the fishing line technique.

Repair of caudal septal deviation using currently described methods is challenging technically. The aim of this work is to describe a novel and simple technique for the treatment of caudal septal deviations that protects the nasal tip, by fixating of cartilage to the columella. All patients with caudal septal deviation operated on between June 2008 to November 2013 in 2 major medical centers were operated using the "fishing line technique." Patient satisfaction was recorded by a standard questionnaire (16-item Sino-Nasal Outcome Test [SNOT-16]), before and after surgery. The fishing line technique was performed in 63 patients with a severe caudal septal deviation of which 14 also had rhinoplasty. A mucoperichondrial flap was elevated on either side of the damaged septal cartilage. The cartilage was excised and remodeled into a straight sheet, and then repositioned between the mucoperichondrial flaps, and fixed to the septal columella. Mean age of the study group was 36 years. Follow-up ranged from 24 to 70 months. At the last follow-up, the septum was straight in all cases, with no deviation from the nostrils to the choana. Good airway was found in 53 patients. Eight patients had partial turbinate hypertrophy with an impaired airway, and 2 had severe turbinate hypertrophy. SNOT-16 mean score improved from 27 to 10 (p < 0.001). All patients were satisfied with the aesthetic outcome. The fishing-line technique for severe caudal septum deviations is easy to perform and yields satisfactory anatomic and aesthetic results.

The Tongue-in-Groove Technique in Primary and Revision Rhinoplasty.

The tongue-in-groove (TIG) is a conservative but powerful surgical suture technique to control tip rotation and projection, to set an appropriate alar-columellar relationship, to straighten a caudal septal deviation, and to stabilize the nasal base. TIG is suitable in primary and most revision cases and is easily combined with other surgical techniques. Seventeen years after its popularization, the TIG technique is embedded in modern-day rhinoplasty literature and teaching material. This article describes indications and considerations during external primary and revision rhinoplasty, based on clinical experience and the available literature.