Minimally Invasive Cutting and Suture Technique for the Management of Caudal Septal Deviation

Surgery for caudal septal deviations is challenging due to cartilage shape memory, the need for adequate nasal tip and dorsal septal support, and long-term healing effects. Here, we report a new surgical method for caudal septal deviations called the minimally invasive cutting and suture technique (MICST). Although similar to the cutting and suture technique, MICST preserves the tissue around the posterior septal angle by maintaining the continuity of the nasal septum cartilage from the keystone area to the anterior nasal spine. The direction of the cutting line is parallel to the dorsal line of the nose, allowing it to release excess pressure from both dorsal and caudal deviations.

A total of 45 patients underwent MICST between September 2022 and August 2023. We analyzed data collected preoperatively and 3 months postoperatively to compare the cross-sectional area ratios of the convex side (narrower) and the concave side (wider), known as the N/W ratio and nasal tip height (using computed tomography), visual analog scale, and operative time with those of 45 patients who underwent the standard cutting and suture technique (CST) between September 2020 and July 2022.

Significant differences were not observed in preoperative and postoperative N/W ratio, and visual analog scale scores between the MICST and CST groups. The proportion of cases in which the nasal tip decreased by ≥3 mm was higher in the CST group, and the operative time was shorter in the MICST group.

The improvement of nasal obstruction using MICST is equivalent to that of CST. Compared to conventional methods, MICST results in the more conservative treatment of the nasal septal cartilage, carries a smaller risk of external nasal deformity, allows correction of dorsal deviation, and does not require a batten graft. The procedure is straightforward and can be performed in a short time.