Cartilaginous Batten Graft Septoplasty in Caudal Septal Deviation

A prospective study will be conducted over 15 patients indicated for septoplasty. Preoperative assessment: History * NOSE (nasal obstruction septoplasty effectiveness score): Higher NOSE scores indicate worse nasal obstruction (range: 0-100). * Visual analogue scale (VAS) (0-10) of nasal obstruction:For nasal obstruction Examination: * Anterior rhinoscopy: to confirm caudal septal deviation. * Endoscopic nasal examination: to exclude HIT, polyp, mass and discharge. * Basal view photograph. * CT nose and paranasal sinuses to exclude other pathology. Operative procedures: * General anesthesia. * Hemitransfixtion incision on the concave side * The mucoperichondrial flap of the septum will be elevated * A contralateral flap will be elevated from the caudal aspect of the cartilage * Subperichondrial dissection into the nasal floor * The curved portion of the septal cartilage will be harvested by excision, leaving an L-strut of dorsal and caudal cartilaginous septum * A caudal septal batten graft created from harvested septal cartilage, then will be sutured using three or four stitches (5-0 polydioxanone sutures). * If C-shaped caudal deviation without angulation or dislocation, cartilaginous batten graft fixed on the concave side * If there is angulation of caudal septal end, the caudal strut will be cut by scissors at the most convex point in the caudocephalic direction. Excessive lower and upper caudal struts will be overlapped and sutured together with batten graft * If dislocated, the septal cartilage will be separated from the anterior nasal spine (ANS) and maxillary crest for reposition. If there is an excessive cartilage portion, it will be removed and then the graft will be sutured * The hemitransfixion incision will be closed using 5-0 Vicryl * Internal nasal splint and anterior nasal pack will be placed in both sides