Transcutaneous Columellar Strut for Correcting Caudal Nasal Septal Deviation

  • Jahangir Ghorbani
  • Mohammad Ganjali
  • Gilda Givehchi
  • Mahdi Zangi
Original Article


Correction of caudal septal deviation is a challenging issue because of its significant role in tip support mechanisms. Some interventions especially aggressive resection of caudal septum to correct deviation, may compromise external nasal valve, tip ptosis and persistence of nasal obstruction. Many surgical techniques have been suggested to correct this type of nasal septal deviation. This study presents a technique to correct caudal septal deviation without weakening of tip support mechanisms. To evaluate the efficacy of insertion of a transcutaneous columellar strut during correction of caudal septal deviation. The study was performed in patients complaining from nasal obstruction with caudal septal deviation. After intranasal incision and elevation of mucoperichondrial flap, Caudal septum released from anterior nasal spine (ANS) and a band of cartilage removed from inferior and caudal part of septum and septum again fixed to ANS. Through a vertical transcutaneous incision, a cartilaginous strut is placed in columella, between medial crurae. Preoperative and postoperative NOSE score determined and photographs were taken. In 14 patients we performed this technique, the postoperative NOSE score showed significant improvement, (p = 0.001). Nasal breathing improved in all patients without any complication or tip ptosis or worsening of nasal appearance. This septoplasty technique along with placement of transcolumellar strut, is an easy, efficient and complication free method for simultaneously correction of caudal deviation of nasal septum, reinforcing external nasal valve and prevents tip ptosis.


Septoplasty Rhinoplasty Nasal septum Caudal septal deviation 



We would like to acknowledge our artist, Miss Maryam Maher.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Chandra RK, Patadia MO (2009) Diagnosis of nasal airway obstruction. Otolaryngol Clin N Am 42:207–225CrossRefGoogle Scholar
  2. 2.
    Haack J, Papel ID (2009) Caudal septal deviation. Otolaryngol Clin N Am 42(427–36):4Google Scholar
  3. 3.
    Giacomini P, Lanciani R, Di Girolamo S, Ferraro S, Ottaviani F (2010) Caudal septal deviation correction by interlocked graft technique. Ann Plast Surg 65:280–284CrossRefPubMedGoogle Scholar
  4. 4.
    Shaida AM, Kenyon GS (2000) The nasal valve: changes in anatomy and physiology in normal subjects. Rhinology 38:7–12PubMedGoogle Scholar
  5. 5.
    Lee J, White WM, Constantinides M (2009) Surgical and nonsurgical treatments of the nasal valve. Otolaryngol Clin N Am 42:495–511CrossRefGoogle Scholar
  6. 6.
    Barrett DM, Casanueva FJ, Cook TA (2016) Management of the nasal valve. Facial Plast Surg Clin N Am 24:219–234CrossRefGoogle Scholar
  7. 7.
    Grymer LF, Hilberg O, Elbrond O, Pedersen OF (1989) Acoustic rhinometry: evaluation of the nasal cavity with septal deviations, before and after septoplasty. Laryngoscope 99:1180–1187PubMedGoogle Scholar
  8. 8.
    Garcia LBS, de Oliveira PW, de Aguiar Vidigal T, de Magalhaes Suguri V, de paula Santos R, Carlos Gregorio L (2011) Caudal septoplasty: efficacy of a surgical technique-preliminary report. Braz J Otorhinolaryngol 77:178–184CrossRefPubMedGoogle Scholar
  9. 9.
    Metzenbaum M (1929) Replacement of the lower end of the dislocated septal cartilage versus submucous resection of the dislocated end of the septal cartilage. Arch Otolaryngol 9:282–296CrossRefGoogle Scholar
  10. 10.
    Ellis MS (1980) Suture technique for caudal septal deviations. Laryngoscope 90:1510–1512PubMedGoogle Scholar
  11. 11.
    Kridel RWH, Scott BA, Foda HMT (1999) The tongue-in-groove technique in septorhinoplasty a 10-year experience. Arch Facial Plast Surg 1:246–256CrossRefPubMedGoogle Scholar
  12. 12.
    Digman RO (1956) Correction of nasal deformities due to defects of the septum. Plast Reconstr Surg 18:291–304CrossRefGoogle Scholar
  13. 13.
    Zimbler MS (2015) Aesthetic facial analysis. In: Flint PW, Haughey BH, Lund VJ, Niparko JK, Robbins KT, Thomas JR, Lesperance MM (eds) Cummings otolaryngology head and neck surgery, 6th edn. Elsevier Saunders, Philadelphia, pp 273–285Google Scholar
  14. 14.
    Stewart MG, Witsell DL, Smith TL, Weaver EM, Yueh B, Hannley MT (2004) Development and validation of the nasal obstruction symptom evaluation (NOSE) scale. Otolaryngol Head Neck Surg 130:157–163CrossRefPubMedGoogle Scholar
  15. 15.
    Jang YJ, Yeo NK, Wang JH (2009) Cutting and suture technique of the caudal septal cartilage for the management of caudal septal deviation. Arch Otolaryngol Head Neck Surg 135:1256–1260CrossRefPubMedGoogle Scholar
  16. 16.
    Chung YS, Seol JH, Choi JH (2014) How to resolve the caudal septal deviation? clinical outcomes after septoplasty with bony batten graft. Laryngoscope 124:1771–1776CrossRefPubMedGoogle Scholar
  17. 17.
    Surowitz J, Lee MK, Most SP (2015) Anterior septal reconstruction for treatment of severe caudal septal deviation: clinical severity and outcome. Otolaryngol Head Neck Surg 153:27–33CrossRefPubMedGoogle Scholar
  18. 18.
    Kim DW, Rodriguez-Bruno K (2009) Functional rhinoplasty. Facial Plast Surg Clin N Am 17:115–131CrossRefGoogle Scholar
  19. 19.
    Sedwick JD, Lopez AB, Gajewski BJ, Simons RL (2005) Caudal septoplasty for treatment of septal deviation aesthetic and functional correction of nasal base. Arch Facial Plast Surg 7:158–162CrossRefPubMedGoogle Scholar
  20. 20.
    Constantine FC, Ahmad J, Geissler P, Rohrich RH (2014) Simplifying the management of caudal septal deviation in rhinoplasty. Plast Reconstr Surg 134:379eCrossRefPubMedGoogle Scholar
  21. 21.
    Anderson JR (1984) A reasoned approach to nasal base surgery. Arch Otolaryngol 110:349–358CrossRefPubMedGoogle Scholar
  22. 22.
    Westreich RW, Lawson W (2008) The tripod theory of nasal tip support revisited the cantilevered spring model. Arch Facial Plast Surg 10:170–179CrossRefPubMedGoogle Scholar
  23. 23.
    Sadeghi M, Saedi B, Sazegar AA, Amiri M (2009) The role of columellar struts to gain and maintain tip projection and rotation: a randomized blinded trial. Am J Rhinol Allergy 23:47e–50eCrossRefGoogle Scholar
  24. 24.
    Bloom DC, Cupp CL (2003) The percutaneous columellar strut. Am J Rhinol 17:357–361CrossRefPubMedGoogle Scholar
  25. 25.
    Aiach GC, Gerbault OF, Kelly MH (2011) Secondary rhinoplasty. In: Nahai F (ed) The art of aesthetic surgery principles and techniques, 2nd edn. Quality Medical Publishing, ST. Louis, pp 2024–2100Google Scholar

Copyright information

© Association of Otolaryngologists of India 2018

Authors and Affiliations

  • Jahangir Ghorbani
    • 1
  • Mohammad Ganjali
    • 2
  • Gilda Givehchi
    • 3
  • Mahdi Zangi
    • 4
  1. 1.Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD)Shahid Beheshti University of Medical SciencesTehranIran
  2. 2.Shahid Beheshti University of Medical SciencesTehranIran
  3. 3.Private PracticeTehranIran
  4. 4.Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD)Shahid Beheshti University of Medical SciencesTehranIran

Personalised recommendations