Cable and Mirror Sutures and the Nasal Septum Sublaminar Dissection

Abstract

Managing the nasal septum (NS) position is crucial in septorhinoplasty. The analysis and the preparation of the anterior nasal spine and the quadrangular cartilage as well as the strategy defined to efficiently stabilize the septum will dictate considerably the success of the result. Moreover, what we see in the surgical table can suffer modifications during the healing process because of poor fixation or the cheese-wire effect of the cartilage. We will present a logical sequence and tools to achieve a proper and stable position of the NS and the nasal pyramid. The sublaminar (supraperichondral) dissection of the quadrangular cartilage as an option to the subperichondral one and the use of cable and mirror sutures to three-dimensionally positioning and stabilizing the NS will be described.

Keywords

cable sutures - mirror sutures - sublaminar dissection - supraperichondral dissection - anterior nasal spine

Publication History

Accepted Manuscript online:
27 January 2023

Article published online:
20 March 2023

• References

• 1 Çerçi Özkan A. “Dual-knot fixation” technique for better stabilization of the extended columellar strut graft with the anterior nasal spine. Aesthetic Plast Surg 2019; 43 (01) 202-205
• 2 Toriumi DM. Structure rhinoplasty: lessons learned in 30 years. DMT Solutions 2019; 1: 96-126
• 3 Daniel RK, Pálházi P. Rhinoplasty: An Anatomical and Clinical Atlas. Springer International Publishing; 2018: 300-301
• 4 Goksel A, Saban Y, Tran KN. Biomechanical nasal anatomy applied to open preservation rhinoplasty. Facial Plast Surg 2021; 37 (01) 12-21
• 5 Freer OT. The correction of deflections of the nasal septum with minimum of traumatization. JAMA 1902; 4: 61-69
• 6 Killian G. Die submucosa Fenster resetion der Nasenscheidewand. Arch Laryngol Rhinol 1904; 16: 362-387
• 7 Agaman G, Kabeer NA. A comparative study on the surgical outcome of submucous resection and septoplasty. Int J Otorhinolaryngol Head Neck Surg 2020; 6 (09) 1623
• 8 Çakir B, Oreroğlu AR, Doğan T, Akan M. A complete subperichondrial dissection technique for rhinoplasty with management of the nasal ligaments. Aesthet Surg J 2012; 32 (05) 564-574
• 9 Genç B, Akkuş AM, Çakır B. Key points in subperichondrial-subperiosteal dissection. Facial Plast Surg Clin North Am 2021; 29 (01) 39-45
• 10 Patron V, Hitier M, Gamby R, Finocchi V, Çakir B. How to perform subperichondrial and subperiosteal rhinoplasty. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136 (04) 325-329
• 11 Neves JC, Zholtikov V, Cakir B, Coşkun E, Arancibia-Tagle D. Rhinoplasty dissection planes (subcutaneous, sub-SMAS, supra-perichondral, and sub-perichondral) and soft tissues management. Facial Plast Surg 2021; 37 (01) 2-11
• 12 Neves JC, Arancibia-Tagle D, Dewes W, Ferraz M. The segmental preservation rhinoplasty: the split Tetris concept. Facial Plast Surg 2021; 37 (01) 36-44
• 13 Neves JC, Arancibia-Tagle D. Avoiding aesthetic drawbacks and stigmata in dorsal line preservation rhinoplasty. Facial Plast Surg 2021; 37 (01) 65-75
• 14 Neves JC, Tagle A, Dewes W. et al. The split preservation rhinoplasty: “the Vitruvian Man split maneuver”. European Journal of Plastic Surgery 2020; 43: 323-333