Becker Rhinoplasty Center
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DR BECKER IS NOW TREATING RHINOPLASTY PATIENTS BY TELEHEALTH.

During the COVID-19 state of emergency, in order to protect our patients and staff, but in order to communicate with patients and plan for the future, Dr Becker will communicate with potential rhinoplasty patients by Telehealth. Telehealth appointments may be scheduled on the phone (our operators our working remotely). Visits will be performed by audio or video discussion.

Becker Rhinoplasty Center
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856-772-1617
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  • Meet the Doctor
  • Procedures
    • Rhinoplasty
    • Revision Rhinoplasty
  • Photos
    • Bulbous Tip
    • Droopy Nose
    • Ethnic Rhinoplasty
    • Finesse Rhinoplasty
    • Nasal Bump
    • Nasal Fracture
    • Narrow Nose
    • Overprojected
    • Revision Rhinoplasty
    • Saddle Nose
    • Twisted Nose
    • Underprojected
    • Unique Issues
    • Upturned Nose
    • Wide Nose
  • Testimonials
    • Patient Reviews
    • Testimonial Videos
  • Videos
    • Testimonial Videos
    • Educational Videos
  • Patient Education
    • Nose Form & Function
    • A Patient’s Guide
    • Books & Publications
    • Revision Rhinoplasty Textbook
    • Rhinoplasty Education
    • Rhinoplasty Dissection Manual
  • Locations
    • Sewell Office
    • Voorhees Office

Chapter 11 – Deviated Caudal Septum

A number of maneuvers are at the surgeon’s disposal in the treatment of a caudal septal deviation (4,5). Traditional approaches include scoring the septal cartilage on the concave side, thereby relaxing the “spring” of the cartilage. This may be done as a solitary maneu ver, or in conjunction with a so-called “swinging door maneuver.” As illustrated in Fig. 3, a wedge of cartilage excised along the maxillary crest releases the caudal septal attach ments and allows the septum to swing to the midline. The midline position may be secured with a 4-0 PDS attached to the periosteum adjacent to the opposite side of the nasal spine.

Ethmoid bone splinting grafts or sandwich grafts also may be of benefit in this situation (6). A straight piece of bone is harvested; a large straight Keith needle may be used as a delicate hand-held drill to make holes in the bone graft. The deviated portion of cartilaginous septum may be addressed by scoring on the concave side, and the bone graft or grafts may then be used to splint the septum in a straighter orientation. However, use of the ethmoidbone graft in this location thickens the caudal septum and can contribute to nasal obstruction. The ethmoid bone sandwich grafts may be used to address a deviation of the dorsal septum, where the additional septal thickness caused by this graft is well tolerated (Fig. 4).

In cases of a severely deviated caudal and dorsal septum, the offending portion may be excised and replaced with a straight piece of cartilage, typically harvested from the septum more posteriorly (Fig. 5) (4). Suture fixation to a stable segment of cartilage attached at the osseocartilaginous junction and nasal spine will allow reconstruction of an intact L-strut to support the lower third of the nose. The reconstructed caudal segments can be sutured between the medial crura to set nasal length, projection, rotation, and the alar/columellar relation.

Nose Job Sewell NJ Proceedures
Figure 3. Deviated caudal septum, “swinging door” maneuver.
Nose Job Sewell NJ Proceedures
Figure 4. A splinting graft of ethmoid bone may help maintain the septum in a straighter orientation.
Nose Job Sewell NJ Proceedures
Figure 5 A
Nose Job Sewell NJ Proceedures
Figure 5 G
Nose Job Sewell NJ Proceedures
Figure 5 H
Nose Job Sewell NJ Proceedures
Figure 5 U
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Figure 5 V
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Figure 5 W
Nose Job Sewell NJ Proceedures
Figure 5 X
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Figure 5 Y
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Figure 5 Z
Nose Job Sewell NJ Proceedures
Figure 5

Figure 5. Septal replacement for severe cases of deviated caudal and dorsal septum. In the first case example, a segment of caudal septum is removed and replaced with a straight piece of septal cartilage harvested posteriorly. As illustrated, the replacement cartilage is extended caudally and se-cured between the medial crura as well. In this case, a tip graft also was applied. Preoperative and postoperative comparison. This series of intraoperative photographs illustrates total replacement of the severely deviated caudal septum. The severely deviated component is removed, along with posterior septum. The deviated septum is replaced with straight septal cartilage harvested posteriorly. A tip graft also was applied.

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REVIEWS

"Dr. Daniel Becker is the sweetest most caring person. It’s almost a year since I had a really bad nose bleeds and he was there for us, came to hospital in the snow on a Sunday just to fix me. He is so very special and always there when you need him. Love him!!!"

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