DOI QR코드

DOI QR Code

Obtaining Maximal Stability with a Septal Extension Technique in East Asian Rhinoplasty

  • Received : 2013.09.11
  • Accepted : 2013.11.02
  • Published : 2014.01.15

Abstract

Recently, in Korea, the septal extension graft from the septum or rib has become a common method of correcting a small or short nose. The success rate of this method has led to the blind faith that it provides superior tip projection and definition, and to the failure to notice its weaknesses. Even if there is a sufficient amount of cartilage, improper separation or fixation might waste the cartilage, resulting in an inefficient operation. Appropriate resection and effective fixation are essential factors for economical rhinoplasty. The septal extension graft is a remarkable procedure since it can control the nasal tip bidirectionally and three dimensionally. Nevertheless, it has a serious drawback since resection is responsible for septal weakness. Safe resection and firm reconstruction of the framework should be carried out. Operating on the basis of the principle of "safe harvest" and rebuilding the structures is important. Further, it is important to learn several techniques to manage septal weakness, insufficient cartilage quantity, and failure of the rigid frame during the surgery.

Keywords

References

  1. Byrd HS, Andochick S, Copit S, et al. Septal extension grafts: a method of controlling tip projection shape. Plast Reconstr Surg 1997;100:999-1010. https://doi.org/10.1097/00006534-199709001-00026
  2. Ha RY, Byrd HS. Septal extension grafts revisited: 6-year experience in controlling nasal tip projection and shape. Plast Reconstr Surg 2003;112:1929-35. https://doi.org/10.1097/01.PRS.0000091424.69765.0C
  3. Byrd HS, Salomon J, Flood J. Correction of the crooked nose. Plast Reconstr Surg 1998;102:2148-57. https://doi.org/10.1097/00006534-199811000-00055
  4. Cardenas-Camarena L, Gomez RB, Guerrero MT, et al. Cartilaginous behavior in nasal surgery: a comparative observational study. Ann Plast Surg 1998;40:34-8. https://doi.org/10.1097/00000637-199801000-00007
  5. van der Heijden P, Korsten-Meijer AG, van der Laan BF, et al. Nasal growth and maturation age in adolescents: a systematic review. Arch Otolaryngol Head Neck Surg 2008;134:1288-93. https://doi.org/10.1001/archoto.2008.501
  6. Rotter N, Tobias G, Lebl M, et al. Age-related changes in the composition and mechanical properties of human nasal cartilage. Arch Biochem Biophys 2002;403:132-40. https://doi.org/10.1016/S0003-9861(02)00263-1
  7. Kim JS, Han KH, Choi TH, et al. Correction of the nasal tip and columella in Koreans by a complete septal extension graft using an extensive harvesting technique. J Plast Reconstr Aesthet Surg 2007;60:163-70. https://doi.org/10.1016/j.bjps.2006.03.055
  8. Kim JS, Jang PY, Choi TH, et al. The dimension of the septal cartilage using the cadaver study. J Korean Soc Aesthetic Plast Surg 2006;12:29-32.
  9. Hwang K, Huan F, Kim DJ. Mapping thickness of nasal septal cartilage. J Craniofac Surg 2010;21:243-4. https://doi.org/10.1097/SCS.0b013e3181c5a203
  10. de Pochat VD, Alonso N, Figueredo A, et al. The role of septal cartilage in rhinoplasty: cadaveric analysis and assessment of graft selection. Aesthet Surg J 2011;31:891-6. https://doi.org/10.1177/1090820X11424149
  11. Mowlavi A, Masouem S, Kalkanis J, et al. Septal cartilage defined: implications for nasal dynamics and rhinoplasty. Plast Reconstr Surg 2006;117:2171-4. https://doi.org/10.1097/01.prs.0000218182.73780.d2
  12. Suh MK. Asian rhinoplasty. Seoul: KAPS; 2012.
  13. Mau T, Mau ST, Kim DW. Cadaveric and engineering analysis of the septal L-strut. Laryngoscope 2007;117:1902-6. https://doi.org/10.1097/MLG.0b013e3181255ec4
  14. Hubbard TJ. Exploiting the septum for maximal tip control. Ann Plast Surg 2000;44:173-80. https://doi.org/10.1097/00000637-200044020-00009
  15. Oh SH, Kang NH, Woo JS, et al. Stabilization of unilateral septal extension graft using pivot locking Suture. J Korean Soc Aesthetic Plast Surg 2008;14:156-60.
  16. Gruber RP, Nahai F, Bogdan MA, et al. Changing the convexity and concavity of nasal cartilages and cartilage grafts with horizontal mattress sutures: part I. Experimental results. Plast Reconstr Surg 2005;115:589-94. https://doi.org/10.1097/01.PRS.0000150145.39509.DB
  17. Gruber RP, Nahai F, Bogdan MA, et al. Changing the convexity and concavity of nasal cartilages and cartilage grafts with horizontal mattress sutures: part II. Clinical results. Plast Reconstr Surg 2005;115:595-606. https://doi.org/10.1097/01.PRS.0000150146.04465.81
  18. Calderon-Cuellar LT, Trujillo-Hernandez B, Vasquez C, et al. Modified mattress suture technique to correct anterior septal deviation. Plast Reconstr Surg 2004;114:1436-41.
  19. Gorur K, Polat G, Ozcan C, et al. The role of apoptosis in traumatic versus nontraumatic nasal septal cartilage. Plast Reconstr Surg 2007;119:1773-6. https://doi.org/10.1097/01.prs.0000259089.98720.9f
  20. Holt GR. Biomechanics of nasal septal trauma. Otolaryngol Clin North Am 1999;32:615-9. https://doi.org/10.1016/S0030-6665(05)70159-6
  21. Richmon JD, Sage A, Wong WV, et al. Compressive biomechanical properties of human nasal septal cartilage. Am J Rhinol 2006;20:496-501. https://doi.org/10.2500/ajr.2006.20.2932
  22. Toriumi DM. New concepts in nasal tip contouring. Arch Facial Plast Surg 2006;8:156-85. https://doi.org/10.1001/archfaci.8.3.156
  23. Toriumi DM. Structural approach to primary rhinoplasty. Aesthet Surg J 2002;22:72-84. https://doi.org/10.1067/maj.2002.122071
  24. Dhong ES. Septorhinoplasty: endoscopic approach and reinforcement of nasal support line. J Korean Soc Aesthetic Plast Surg 2010;16:111-6.
  25. Kim DW, Egan KK, O'Grady K, et al. Biomechanical strength of human nasal septal lining: comparison of the constituent layers. Laryngoscope 2005;115:1451-3. https://doi.org/10.1097/01.mlg.0000168579.94187.f6
  26. Daniel RK, Letourneau A. Rhinoplasty: nasal anatomy. Ann Plast Surg 1988;20:5-13. https://doi.org/10.1097/00000637-198801000-00004
  27. Kim JH. Surgical guides for overcoming disadvantages of septal extension geaft in Asians. In: Jeong JY, editor. Proceedings of the Rhinoplasty Symposium Seoul 2009: basic and advanced; 2009 June 21; Seoul: Nine Add Press; 2009. p. 54-7.
  28. Han SK, Ko HW, Lee DY, et al. The effect of releasing tip-supporting structures in short-nose correction. Ann Plast Surg 2005;54:375-8. https://doi.org/10.1097/01.sap.0000154860.04003.4b
  29. Jeong JY. Tripod framework rebuilding in Asian nose: tip plasty using alar advancement technique. J Korean Soc Aesthetic Plast Surg 2010;16:125-38.
  30. Jeong JY, Yoo YA, Kang NH, et al. expansion procedures of the nasal envelope in short nose deformity: release of the transverse nasalis sling and division of muscle confluence in nasal hinge area. J Korean Soc Aesthetic Plast Surg 2010;16:78-84.
  31. Azizzadeh B, Murphy MR, Johnson Jr CM, et al. Master techniques in rhinoplasty. Philadelphia, PA: Saunders; 2011.
  32. Oh SH, Choi S, Kim DW, et al. Intranasal approach for manipulating the depressor septi nasi. J Craniofac Surg 2012;23:367-9. https://doi.org/10.1097/SCS.0b013e318240ca4c
  33. Ghavami A, Janis JE, Guyuron B. Regarding the treatment of dynamic nasal tip ptosis with botulinum toxin A. Plast Reconstr Surg 2006;118:263-4. https://doi.org/10.1097/01.prs.0000222208.50992.7a
  34. Kim J. The Attractiveness of facial asymmetry in normal population. J Korean Soc Aesthetic Plast Surg 2000;6:165-70.
  35. Daniel RK, Cox C. Mastering rhinoplasty. 2nd ed. Berlin: Springer; 2010.
  36. Han K, Yeo HJ, Choi TH, et al. Rhinoplasty using Various Autogenous Tissues. J Korean Soc Plast Reconstr Surg 2010;37:37-45.
  37. Boenisch M, Tamas H, Nolst Trenite GJ. Morphological and histological findings after typical surgical manipulations on growing septal cartilage in rabbits. Facial Plast Surg 2007;23:231-7. https://doi.org/10.1055/s-2007-995815

Cited by

  1. Caudal Septal Extension Graft Using Nasal Septal Osteocartilaginous Graft vol.58, pp.11, 2014, https://doi.org/10.3342/kjorl-hns.2015.58.11.793
  2. Schwannoma of the Membranous Nasal Septum: a Clinical Report With Aesthetic Approach vol.29, pp.2, 2018, https://doi.org/10.1097/scs.0000000000004092
  3. Nasal Elongation with Septal Half Extension Graft: Modification of Conventional Septal Extension Graft Using Minimal Septal Cartilage vol.42, pp.6, 2014, https://doi.org/10.1007/s00266-018-1219-6
  4. Caudal Septal Extension Graft Sutured with Absorbable Material and Not Fixed to the Nasal Spine Region Compared with the Conventional Fixation Method: A Retrospective Study vol.43, pp.3, 2014, https://doi.org/10.1007/s00266-019-01330-8
  5. Surgical anatomy for Asian rhinoplasty: Part II vol.21, pp.3, 2014, https://doi.org/10.7181/acfs.2020.00234
  6. A Case of Nasal Septal Abscess Localized at Keystone Area, Suspected of Occurring Following Cauterization for Epistaxis vol.31, pp.1, 2014, https://doi.org/10.35420/jcohns.2020.31.1.74
  7. Deviated nose: Physiological and pathological changes of the nasal cavity vol.47, pp.6, 2020, https://doi.org/10.5999/aps.2020.01781
  8. Optimal harvest and efficient use of septal cartilage in rhinoplasty vol.22, pp.1, 2021, https://doi.org/10.7181/acfs.2020.00486