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DOI: 10.1055/s-0036-1585423
Septal Surgery Challenges in Rhinoplasty
Publication History
Publication Date:
05 August 2016 (online)
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Abstract
During rhinoplasty, the most stressful areas of the nasal cartilaginous septum are at the key area and anterior nasal spine. A stable fixation of the caudal septum to respond to these stresses is of utmost importance. The prerequisite for a successful fixation is a well-prepared recipient bed for caudal septum and suture fixation. The bed can be opened by using scissors, osteotome, or powered instrumentation. Simple or multiple sutures passing from the bone and/or surrounding soft tissues are used for fixation. At the key area, if a complete separation of the L-strut occurs, it should be sutured to nasal bones and upper lateral cartilages. The septum should be supported by splinting spreader grafts to increase stability. To prevent dorsal irregularities, a dorsal onlay camouflage graft should be used. The best way is to take cautions to prevent such a mishap. That is why a dorsal segment of 12 to 15 mm should be preserved, at least at the key area, and part of the mucoperichondrium should stay attached to the septum.
Keywords
septoplasty - rhinoplasty - key area - separation of the L-strut - subluxation - caudal septum - spreader graftsNote
This work was done at the Department of Otorhinolaryngology, Ege University Medical Faculty, Bornova, İzmir, Turkey
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References
- 1 Killian G. The submucous window resection of the nasal septum. Ann Otol Rhinol Laryngol 1905; 14: 363
- 2 Metzenbaum M. Replacement of the lower end of the dislocated septal cartilage versus submucous resection of the dislocated end of the septal cartilage. Arch Otolaryngol 1929; 9: 282-292
- 3 Peer L. An operation to repair lateral displacement of the lower border of septal cartilage. Arch Otolaryngol 1937; 25: 475-477
- 4 King ED, Ashley FL. The correction of the internally and externally deviated nose. Plast Reconstr Surg (1946) 1952; 10 (2) 116-120
- 5 Rees TD. Surgical correction of the severely deviated nose by extramucosal excision of the osseocartilaginous septum and replacement as a free graft. Plast Reconstr Surg 1986; 78 (3) 320-330
- 6 Gubisch W. The extracorporeal septum plasty: a technique to correct difficult nasal deformities. Plast Reconstr Surg 1995; 95 (4) 672-682
- 7 Toriumi DM. Subtotal reconstruction of the nasal septum: a preliminary report. Laryngoscope 1994; 104 (7) 906-913
- 8 Surowitz J, Lee MK, Most SP. Anterior septal reconstruction for treatment of severe caudal septal deviation: clinical severity and outcomes. Otolaryngol Head Neck Surg 2015; 153 (1) 27-33
- 9 Jugo SB. Total septal reconstruction through decortication (external) approach in children. Arch Otolaryngol Head Neck Surg 1987; 113 (2) 173-178
- 10 Wright WK. Principles of nasal septum reconstruction. Trans Am Acad Ophthalmol Otolaryngol 1969; 73 (2) 252-255
- 11 Pastorek NJ, Becker DG. Treating the caudal septal deflection. Arch Facial Plast Surg 2000; 2 (3) 217-220
- 12 Mau T, Mau ST, Kim DW. Cadaveric and engineering analysis of the septal L-strut. Laryngoscope 2007; 117 (11) 1902-1906
- 13 Lee SJ, Liong K, Tse KM, Lee HP. Biomechanics of the deformity of septal L-struts. Laryngoscope 2010; 120 (8) 1508-1515
- 14 Apaydin F. Segmental reconstruction for nasal septal deviation. Facial Plast Surg 2013; 29 (6) 455-463
- 15 Toriumi DM. Subtotal septal reconstruction: an update. Facial Plast Surg 2013; 29 (6) 492-501
- 16 André RF, Vuyk HD. Reconstruction of dorsal and/or caudal nasal septum deformities with septal battens or by septal replacement: an overview and comparison of techniques. Laryngoscope 2006; 116 (9) 1668-1673
- 17 Foda HM. The role of septal surgery in management of the deviated nose. Plast Reconstr Surg 2005; 115 (2) 406-415
- 18 Gunter JP, Cochran CS. Management of intraoperative fractures of the nasal septal “L-strut”: percutaneous Kirschner wire fixation. Plast Reconstr Surg 2006; 117 (2) 395-402
- 19 Gubisch W. Extracorporeal septoplasty for the markedly deviated septum. Arch Facial Plast Surg 2005; 7 (4) 218-226
- 20 Gubisch W. Treatment of the scoliotic nose with extracorporeal septoplasty. Facial Plast Surg Clin North Am 2015; 23 (1) 11-22
- 21 Persichetti P, Toto V, Segreto F, Signoretti M, Marangi GF. Modified extracorporeal septoplasty: functional results at 6-year follow-up. Ann Plast Surg 2016; 76 (5) 504-508
- 22 Ross Mobley S, Long J. Extracorporeal septoplasty: assessing functional outcomes using the validated nasal obstruction symptom evaluation score over a 3-year period. Plast Reconstr Surg 2016; 137 (1) 151e-163e