Before (left): severe caudal septal deviation, blocking right nostril entrance. After (left): post extra-corporeal septoplasty, where the caudal septum was replaced with cartilage taken from the deeper septum.
Have you ever noticed that there is some asymmetry of your nostrils? Often it is not due to the diameter of the nostrils themselves, but rather a deviation of the caudal septum. The septum is the wall that separates the nose internally in half. The caudal edge of the septum is the portion that is closest to the nostril entrance. Typically the caudal septum sits between the nostrils precisely, just right behind the columella (the fleshy tissue between your nostrils). If the caudal septum is sitting perfectly in the midline, the width of the nostrils should be similar. However, if the caudal septum is flaring off to one side, it will narrow the nostril on that side.
The caudal septum can be challenging to repair. Deviations deeper inside the nose are often addressed with a septoplasty, in which the surgeon removes deviated cartilage to relieve obstruction. The caudal septum, however, cannot simply be removed because it provides structural support to the nasal tip; removal would cause tip ptosis and loss of tip projection. For that reason, the surgeon usually needs to re-engineer the crooked caudal cartilage and coax it back to the midline, a more demanding task than a standard septoplasty.
Sometimes sutures and grafts of cartilage can straighten a deviated caudal septum. Other times, the caudal septum must be completely replaced with straighter cartilage harvested from the deeper septum. In this case, the caudal septum was deemed too severely bent to salvage. I therefore performed an extracorporeal septoplasty through an external rhinoplasty approach: the caudal septum was resected and reconstructed using straight cartilage grafts from the deeper septum.
The photo shown was taken one month postoperatively and demonstrates relief of right-sided airway obstruction with concurrent nasal tip refinement.
