The Notch-and-Key Technique for Caudal Septal Deviation in Rhinoplasty: A Novel Approach

Abstract

Background: Caudal septal deviation poses a significant challenge in rhinoplasty, affecting both nasal airflow and aesthetic balance. While various techniques such as scoring, swinging door, and batten grafting have been used, many fail to ensure sufficient stabilization or involve extensive dissection, especially in revision cases or in patients with limited septal support. Technique: The notch-and-key technique involves creating interlocking notches in both the deviated caudal septum and a supporting graft. This configuration achieves mechanical fixation through a \"lock-and-key\" principle, securing the caudal septum at the midline without compromising anatomical integrity. The procedure was performed using an open approach in primary rhinoplasty cases. Autologous septal or costal cartilage was used for grafting. Results: Objective angular analysis demonstrated correction rates of 86–100% for anterior–posterior deviation and 89–100% for caudal deviation, corresponding to \"Good\" to \"Excellent\" outcomes. Patient satisfaction on the VAS scale improved by 4–7 points.No complications occurred, and revisions were not necessary during the 12-month follow-up period. Conclusions: The notch-and-key technique offers a safe, reproducible, and structurally sound alternative for caudal septal stabilization. By minimizing dissection and providing strong midline fixation, it facilitates both functional and aesthetic goals of rhinoplasty, especially in cases with isolated caudal deviation. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.