Showing posts with label Caudal Septum Deviation. Show all posts
Showing posts with label Caudal Septum Deviation. Show all posts

Tuesday, September 22, 2020

Caudal Septum Deviation / Dislocation

Anterior Septal Dislocation

The nasal septum is the structure that divides the nasal cavity into two, consisting of cartilage and bone, and covered with mucosa. Columella is the part between the nostrils and when viewed from the outside, between the two nostrils. Curvatures in the nasal septum to one side are called "nasal septum deviation". This curvature, which is found in certain levels in many people, can cause symptoms such as nasal congestion, sleeping with open mouth, dry throat at night, sweating during sleep, and decreased sleep quality when it is excessive. In this case, septoplasty operation can be performed. Classical deviation surgeries are a simple surgical procedure frequently performed by many ENT specialists.

The part closest to the floor of the nasal septum, that is, when you look at the nostrils in front, the part just behind the "columella", which is the part between the holes, "caudal septum" is very important, especially in the nasal tip support and in the shape of the tip of the nose. The curvatures in this section are termed "caudal septum deviation", "caudal septal deviation" or "anterior septal deviation", as my above patient points out, can cause 3 major problems:
  • nasal congestion
  • asymmetric nose tip
  • columellar irregularities

The deviations of the nasal septum that appear outward from the columella, ie the curvatures in the lowest part of the nasal septum, are called "caudal septal deviations". The lower part of the nasal septum is dislocated from the midline to one side (also called "Anterior Septal Dislocation" or "Caudal Septal Dislocation").

There may be many different curvatures in the nasal septum. Nasal septum deviation can vary depending on the species, genetic characteristics, and nasal trauma.

In some types of nasal septum deviation, open technical operations may be required. Especially in nasal septum deviations close to the "nasal valve" area, which is the narrowest airway area in the nose, the complaint of nasal obstruction may be high.

"Anterior septal dislocation" or "caudal septum deviation" between the nasal septum deviations is not only for nasal obstruction; It can also cause asymmetry and functional problems at the tip of the nose. As seen in the photo, the lower part of the cartilage that should sit on the lower bone notch (anterior nasal spine area) has shifted to the side, and when resection of this area is planned, the nasal tip support must be reconstructed using a cartilage graft.

Caudal septal deviations are cartilaginous curvatures in the support part of the nasal septum at the tip of the nose and narrow the nasal valve area, which is the narrowest part of the nose. Therefore, the surgical correction of caudal septum deviations is more difficult than classical nasal septum deviations. The video above shows the caudal deviation visible from the right nostril and obstructing the left air passage.

Patients with caudal septum deviation usually have a protrusion that can be seen from the front just behind the columella and inside the nostril, and further back in the opposite nasal cavity, as seen in the above photo, septum deviation. Patients may notice the relief of nasal breathing when pulling their cheeks sideways with their hands.

Apart from this, as a result of the lateral sliding of the caudal septum, the nasal tip support decreases, and patients may notice that when they touch the nasal tips, they are softer than normal, and that they spread or hang sideways while laughing. Sometimes, patients may describe a sitting sound instead of a sound due to the movement of the caudal septum area during handling.

Causes of Caudal Septum Deviation

Causes of nasal septum deviation are also valid for caudal septum deviation and can be summarized as follows:
- The most common facial trauma and trauma (perhaps the most common cause of caudal septum deviation, especially at the tip of the nose)
- direct compression and trauma of the nose during childbirth (this can also be considered a congenital disease)
genetic connective tissue disorders such as Marfan syndrome, Homocystinuria, and Ehlers-Danlos syndrome, which can cause septum deviation (sources: Nasal septum deviation / Marfan Syndrome Long-term Survival and Complications After Aortic Aneurysm Repair / Deviated Septum)

Caudal Septum Deviation Surgery

Caudal Septum Deviation / Dislocation

When the curved caudal septum section is removed alone, softening of the nasal tip, nasal tip sagging and retraction in the columella may occur!

The caudal septum contributes to the support of the nasal tip against gravity by being in the midline at the tip of the nose. Removing and removing this curved part, which is very important in the nasal tip support, during the surgical procedure and not making new cartilage support to the nasal tip, may cause a fall in the nasal tip after surgery.

In patients with caudal septum deviation, if the curved part of the septum deviation is surgically removed with the classical closed technique simple cartilage curvature surgery performed through the nose and lasting only a few minutes, loss of support tissue and a fall may occur at the tip of the nose. Therefore, instead of the curved area at the tip of the nose; Different techniques may be required, such as the placement of new cartilage grafts with open technique operation, or the closed technique and the "swinging door technique - swinging door" technique, including stretching and placing it back in the midline rather than completely removing the curved area.

The oldest and most common method for correcting septal caudal dislocations is Metzenbaum's "movable door" technique. Using this technique, the dislocated caudal septum is shifted to the midline and fixed to the nasal spine. In later years, Noorman published a movable gate technique modification involving the use of the maxillary crest as the door stopper after the dislocated septum was shifted to the opposite side of the dislocation. Another method has been defined by Goldman in which cartilage scoring, resection and suture steps are defined. In addition, the modified Goldman technique, involving resection of dislocated caudal septal cartilage and triangular cartilage from suture steps, was described by Lawson. In the literature, two different suture techniques that can be used both to correct caudal septal dislocation and to complement the previous cartilage fixation to cartilage nasal spine techniques have been published in the literature.

The first suture technique has described a caudal septal suture technique that can be used alone or as a complement to prior techniques; A technique is described involving fixation of the dislocated caudal septum with midpoint mattress stitching in the second suture technique with non-absorbable suture material from the outside.

Septoplasty is one of the most important operations in ear, nose and throat applications. Since the most affected area is the anterior part of the nose, the septum must be firmly fixed during suturing at the end of the surgery. It is particularly effective in preventing many complications such as anterior septal deformity repair, supratip depression, columellar retraction and enlargement of the nasal base.

Differences between caudal septum deviation surgery and normal septoplasty operation

In patients with caudal septum deviation, removing only the curved part is not sufficient as in normal deviation operations. This part is very important for the nasal tip support and for the nasal tip to stand upright. If the curvature area is removed, the nasal tip may fall and the nasal airways in the nasal passage area may cause problems such as nasal congestion to reappear over time and nasal deformity. In patients with caudal septum deviation, the open technique should be planned in the form of nasal tip aesthetics, after the front curved part is removed, replacing it with a cartilage graft taken from the back of the septum, or partial resection with a closed technique and placing the septum by sliding it into place. In other words, simple cartilage removal is not sufficient.

The closed technique "swinging door" technique may not always be sufficient!

With the covered technique, in patients with caudal septum deviation, it may be difficult to adjust the position of the caudal septum in the columnellar pocket, expand the algebra, insert the cartilage into the midline pocket and fix it with suture. In addition, it can only stabilize the septum vertically, and when made alone, it may be insufficient for fixation as it is a bearing column and is made at one level. In the patient given in the first photograph, a limited amount of resection (caudal septoplasty operation) was performed in the caudal septum section and external columellar sturt graft was placed in the midline from the outside. Open technical septoplasty operation is required for patients with severe deviation.

Caudal Septum Deviation / Dislocation

Caudal septum deviation surgery (caudal septoplasty surgery) can be performed with open technique or closed technique. When the curvature is excessive, an operation can be planned in the form of open technique nose tip aesthetics or nasal aesthetics. In the video above, an open technique septorhinoplasty operation was performed on the patient.

I generally prefer surgery in the form of open technique septoplasty or open technique nasal tip aesthetics for my patients with caudal septum deviation. In the open technique (external) approach, I prefer the closed technique (endonasal) approach because the surgeon has more control of the nasal tip anatomy and it is easier to place additional support cartilages at the tip of the nose.

Similar links >> What is The "Nasal Septum Deviation" and "Septoplasty Operation"?Open Techique Septoplasty Operation in İstanbul, Turkey / Caudal Septal Deviation

You can find details about "Nasal septum deviation definition - Nasal septum deviation causes - Symptoms of deviated septum - Diagnosis of septum deviation with turbinate hypertrophy - Treatment of nasal septum deviation - Septoplasty in Istanbul - Septoplasty in Turkey" at >> Nasal Septum Deviation - Symptoms, Diagnosis and Treatment

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul
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