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

Sliding Spine Relocation Surgery with Anterior Septal Reconstruction

Study Design: Technical note. Objective: The lower nasal architecture is dependent on caudal septal integrity. Deviations of the caudal septum can compromise nasal airflow. The presence of anterior nasal spine deviations contributes to septal and medial crural shifting with ipsilateral encroachment. It is essential to identify nasal spine deviation during surgery in order to reconstruct the septum in a midline position at its base. This allows an appropriate management plan that creates a better functional and aesthetically pleasing outcome. A stable midline anterior nasal spine is warranted to support the newly reconstructed straight caudal strut, which can be effectively corrected by anterior septal reconstruction. Methods: The proposed method intends to combine anterior nasal spine centralization with correcting caudal septal deviation and nasal obstruction through a modified extracorporeal septoplasty technique. We describe a novel technique to centralize the deviated anterior nasal spine using the piezoelectric device by performing a contralateral adjacent ostectomy and en-bloc relocation and fixation of the anterior nasal spine with microplates and screws. Results: This surgical approach creates a stable caudal septum and a centrally positioned anterior nasal spine, which improves nasal airflow and ensures a stable repair. Conclusion: Sliding spine relocation surgery with anterior septal reconstruction repositions a deviated anterior nasal spine and corrects caudal septum deviation, that can impair the nasal airway.

Correcting Caudal Septal Deviation with a Modified Horizontal Mattress Suture

Correction of caudal septal deviation remains surgically challenging, given its imperative function as a nasal tip stabilizer and factor in tip projection, as well as its impact on the nasolabial angle and length of the nose. Although various procedures have been devised to repair the caudal septum using grafting techniques, correction with minimally invasive isolated suture techniques is limited. In this case report, we describe a modified horizontal mattress suture to correct caudal septal deviation in a patient undergoing revision septorhinoplasty. The patient followed up for 2 years after the surgery, and correction of the anterior caudal septum deviation remained intact.