Background: A deviated septum is one of the most recognized of all deformities of the nose. It is typically seen on the outside as a nose that is deviated or twisted although not every deviated septum causes an externally deviated nose. One unique but not uncommon type of septal deformity is that of the caudal deviation. This is where the front end of the septum is displaced and ends up causing a bulge into the now of the nostrils. Patients readily seen in their nostril asymmetry even if they don’t recognize the cause.
Correction of the caudal septal deviation is typically done through incisions inside the nose usually over its end. (which often is not where the visible nostril bulge is seen) Correction of the septal deviation is based on the principle that its overall size (length and height) is excessive and must be reduced to fit straightly back into place. This may or may not require partial releasing incisions to get the remaining septal cartilage to remain straight. For some patients they will experience an improved breathing by removing the nostril blockage. But all patients will see improvements in the pre-existing nostril asymmetry.
But some caudal septal deviations will be associated with other nasal tip shape deformities such as asymmetric domes and a twisted tip. In this type of caudal septal correction an open approach is usually more effective to comprehensively treat all nasal tip/nostril deformities.
Case Study: 
This young female presented with concerns of a nostril asymmetry caused by something bulging into her right nostril. She also disliked the overall deviated appearance to her nose. She had no breathing difficulties and was otherwise happy with the appearance of her nose.
Under general anesthesia an open rhinoplasty approach was taken to expose and straighten the septum though the exposure provide by the separation of the medial footplates of her lower alar cartilages. A columellar strut graft was used between the medial footplates for support during closure as well as tip reshaping (narrowing) sutures placed.
Through an open rhinoplasty approach the entire septal deviation can be effectively treated as well as some tip refinement as well.
Highlights:
- In nasal deviations the septum is always involved which is most noticeable at is caudal end at the nasal tip.
- Caudal septal deviations present as a mass or bulge into one of the nostrils.
- An open rhinoplasty approach through the medial footplates can be used for visualization and straightening of the septum.
Dr. Barry Eppley
Indianapolis, Indiana