Technique to Fix the Stubborn Deviated Caudal Septum with an Internal Bone Graft Splint

Abstract

Septoplasty, especially of the caudal portion, during cosmetic rhinoplasty is a crucial step in achieving satisfactory straight outcomes for the bony cartilaginous infrastructure and the skin envelope. Many methods are available, which range from septal mucosal resection to internal splinting by bone in a batten fashion; a power tool is usually used. This study describes a simple technique using a nonpower tool to correct the stubborn deviated caudal septum, with a thin available bone.

Methods: Patients who underwent cosmetic open septorhinoplasty for crooked nose deformity and did not respond to the traditional septoplasty techniques were included. Bony splint was harvested from the bony septum and fixed to the caudal septum using an 18-gauge needle to create holes to fix the bony splint to the caudal septum through horizontal matrix sutures to correct septal deviation.

Results: Six rhinoplasty patients who had significant caudal septal deviation and did not respond to the traditional techniques of septoplasty were included in this study. The patients were successfully treated by using an internal bony batten splint to correct the deviation. No postoperative complications were noted, and none of the patients required a revision surgery.

Conclusions: Bony batten graft is not a new concept. It involves correcting the resistant caudal septum deviation by splinting it internally by using power tools and drills to create the holes to fix the bony splint graft. Using an 18-gauge needle to drill the hole is a simple, quick, and effective technique to correct and straighten the septum for resistant cases.

Fig. 1.

Vomer harvested from the bony septum.

Fig. 2.

Vomer bone shaped into rectangular design using a 10 surgical blade.

Fig. 3.

Drilling hole in the vomer using 18-gauge needle with a twisting maneuver.

Fig. 4.

The 18-gauge needle through the vomer bone.

Fig. 5.

Two holes drilled (white arrows show the second of the manual drilled holes in the bony septum).

Fig. 6.

Deviated caudal septum (indicated by the white arrow).

Fig. 7.

Corrected caudal septum after internal bone batten graft fixed with two horizontal mattress sutures. The yellow arrow shows the native caudal septum after correction. The white arrow shows the bony batten sutured to the caudal septum.

Fig. 8.

A 26-year-old male presented with the complaints of nasal deformity, crooked nose, and functional breathing concerns seeking cosmetic rhinoplasty. A–C, Preoperative views with posttraumatic right nasal deviation. D–F, Postoperative views of the patient’s face after 10 days, showing consistent satisfactory results.

Fig. 9.

A healthy 25-year-old woman presented with the complaints of nasal deformity, crooked nose, and functional breathing concerns seeking cosmetic rhinoplasty. A–C, Preoperative views with posttraumatic right nasal deviation. D–F, Postoperative views of the patient’s face after 10 days, showing consistent satisfactory results.