We aim to define a cartilage reshaping and repositioning technique for caudal septal dislocations, with the logic of adapting the smoother tissues to the stiffer structures. The study was designed retrospectively with the patient charts and photographic analysis. Thirty-six patients who had septal surgery in a septoplasty or an open approach septorhinoplasty operation and meet the inclusion criteria were evaluated for the study. Postoperative success of the technique was based on preoperative and postoperative photographic analysis by two independent otorhinolaryngologists. The estimators classified 33 cases as near complete, 3 cases as improved but persisting caudal septal deviation, and any cases with no change. The improvement of the degree of reconstruction was near complete about 87 % in septoplasty and 95 % in septorhinoplasty groups, and 92 % for all patients. In this study, we present a caudal septal repositioning maneuver which achieves a stable anchorage between postero-caudal septal cartilage and nasal spine. Septal cartilage is notched and fixed to nasal spine with two simple independent sutures as lock and key model. We define this maneuver as riding spine technique. It is an anatomic re-orientation between the septum and nasal spine for caudal septal deviations and subluxations.
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