Surgical repair of the caudal end of the septum.

The repair of the caudal end of a severely deviated septum has been a challenge since the beginning of septum surgery. In the time of Freer and Killian, a caudal and dorsal strip was always left. Frequently, the most obvious portion of the septal deformity, the caudal end, was undisturbed and the deformity persisted. Metzenbaum, Fomon and Cottle procedures designed to correct this problem. The procedure described in this presentation utilizes the maxilla-premaxillary approach to the septum. The laporotomy of the rhinoplasty procedure is used to expose the upper lateral cartilages. These cartilages are submucously uncovered and separated from the dorsal margin of the septal cartilage. This provides complete exposure of the line of fracture usually responsible for the extreme deflection of the caudal end of the septal cartilage. A strip of cartilage including the line of fracture is removed. The caudal end is attached to the mucoperichondrium of the right side and now is completely mobile. The caudal end is placed over the maxillary spine and sutured in position by a chromic cat gut suture from the prespine fascia through the caudal edge of the septal cartilage. The upper lateral cartilages are sutured to the dorsal margin of the septum acting as a splint to hold the sections of cartilage straight and immobile until the tissues heal.