www.PRSJournal.com 379e A chieving a consistent functional and aes- thetic result when performing rhinoplasty demands intimate knowledge and under- standing of nasal anatomy and physiology. Cor- rection of the deviated nose is no exception. Accurate preoperative analysis and intraoperative diagnosis are essential to the surgeon’s success. Correction of these deformities poses an array of challenges to the rhinoplasty surgeon because of the dilemma of dealing with both functional and aesthetic problems at the same time. The anatomy of a deviated nose can involve asymmetries of the bony pyramid, a septal abnormality, or asymme- tries of the upper and lower lateral cartilages, but usually involves some combination of these prob- lems. This can result in nasal airway obstruction without external deviation, external deviation without nasal airway obstruction, or external devi- ation with nasal airway obstruction. In addition, facial asymmetries add complexity to the analysis. Classification systems exist for septal deformi- ties 1 and the deviated nose. 2 A multitude of tech- niques to address these deformities, including swinging door flaps, a variety of grafts including battens and spreaders, scoring, wedging, and extra- corporeal septoplasty, have been described. 1–20 Despite these various techniques, management of caudal septal deviation remains challenging. Building on concepts and techniques used to cor- rect posterior septal deviation, 2 this technique has evolved to include the management of the cau- dally deviated septum. Caudal septal deviation is common in patients seeking rhinoplasty. We performed a recent review of 100 consecutive patients in a single surgeon’s practice that showed a 44 percent prevalence of caudal septal deviation. In this article, our current technique for simplifying the management of the Disclosure: Dr. Rohrich receives book royalties from Quality Medical Publishing and instrument royal- ties from Micrins. The other authors have no finan- cial interest to declare in relation to the content of this article. Copyright © 2014 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0000000000000236 Fadi C. Constantine, M.D. Jamil Ahmad, M.D. Palmyra Geissler, M.D. Rod J. Rohrich, M.D. Dallas, Texas; and Mississauga, On- tario, Canada Summary: Correction of the deviated nose poses a challenge in even the most experienced hands. Frequently, the surgeon is faced with both a functional (airway obstruction) and an aesthetic problem that must be addressed con- jointly. Accurate preoperative analysis and intraoperative diagnosis are integral to good outcomes. Caudal septal deviation is frequently present in patients presenting for rhinoplasty. The authors’ current graduated technique for sim- plifying the management of the caudally deviated septum both aesthetically and functionally is described. If there is a persistent caudal septal deviation that has not been addressed by standard maneuvers, the caudal portion of the anterior septum is resected at the osseocartilaginous junction with the anterior nasal spine and maxillary crest and then sutured back to the periosteum of the anterior nasal spine with 5-0 polydioxanone. We have found this to be a safe and effective way of addressing the caudally deviated septum in the majority of cases. (Plast. Reconstr. Surg. 134: 379e, 2014.) From the Department of Plastic Surgery, The University of Texas Southwestern Medical Center; and The Plastic Sur- gery Clinic. Received for publication July 16, 2013; accepted December 12, 2013. Simplifying the Management of Caudal Septal Deviation in Rhinoplasty Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s Web site (www. PRSJournal.com). SPECIAL TOPIC