Facial plast Surg 2016; 32(04): 351-360
DOI: 10.1055/s-0036-1585423
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Septal Surgery Challenges in Rhinoplasty

Fazil Apaydin1
  • 1Department of Otorhinolaryngology, Ege University Medical Faculty, Bornova, İzmir, Turkey
Further Information

Publication History

Publication Date:
05 August 2016 (online)


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.


This work was done at the Department of Otorhinolaryngology, Ege University Medical Faculty, Bornova, İzmir, Turkey