PDF herunterladen
Facial Plast Surg 2006; 22(1): 009-027
DOI: 10.1055/s-2006-939948
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Management of Naso-Septal L-Strut Deformities

David W. Kim1 , Theresa Gurney1
  • 1Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
29. Mai 2006 (online)

    Lizenzen und Reprints

ABSTRACT

Deformities of the naso-septal L-strut create functional and aesthetic problems, such as the twisted nose, the malpositioned tip, the saddle deformity, and internal valve insufficiency. The surgeon must approach these problems with three principles. First, in certain situations, the L-strut must be modified. Second, the L-strut must be structurally stable to support to the nose. Third, the position of the L-strut and its relationship to neighboring structures will determine the changes in nasal form and function. The current article focuses on two common types of deformities of the septal L-strut: deviation and collapse. Mild deviations are addressed through repositioning or camouflaging techniques. Moderate deviations are treated with cartilage-bolstering techniques. Severe deviations are resected and reconstructed with cartilage grafts. Dorsal septal reconstruction or onlay grafting treats collapse. Caudal septal reconstruction and tip-supporting grafts address nasal tip collapse. Total septal loss or collapse requires construction of a new L-strut. These techniques should maintain support to the nose while improving nasal form and function.

KEYWORDS

L-strut - rhinoplasty - saddle nose - septal deviation - septal collapse

REFERENCES

  • 1 Adams W. The treatment of the broken nose by forcible straightening and mechanical apparatus.  BMJ. 1875;  2 421
    PubMedGoogle Scholar
  • 2 Asch M. Treatment of nasal stenosis due to deflective septum with and without thickening of the convex side.  Laryngoscope. 1899;  6 340
    PubMedGoogle Scholar
  • 3 Ingals E F. Deflections of the septum narium.  Arch Laryngol. 1882;  3 291
    PubMedGoogle Scholar
  • 4 Kreig R. Resection der cartilage quadrengularis septi nasem sur heilung der scoliosis septi.  Medicinishes Cocrespondenz blatt Wurtenburgishen Artilicken Verein Stuttgart. 1886;  56 201
    PubMedGoogle Scholar
  • 5 Boenninghaus G. Bemerkungen zun aufsatze loewes: zur chirurgie der nasenscheidewand.  Manatcssche Ohreng. 1900;  34 287
    PubMedGoogle Scholar
  • 6 Freer O T. The correction of deflections of the nasal septum with a minimum of traumatism.  JAMA. 1902;  38 636
    PubMedGoogle Scholar
  • 7 Killian G. Die sumucöse Fenesterresektion der Nasenscheidewand.  Arch Laryngologie Rhinologie. 1904;  16 362
    PubMedGoogle Scholar
  • 8 Mau I T, Kim D W. Surgical Anatomy of the Nose.  , Bailey's; In press
    PubMedGoogle Scholar
  • 9 Toriumi D M, Becker D G. Rhinoplasty Dissection Manual. Philadelphia; Lippincott 1999
    Google Scholar
  • 10 Kim D W, Egan K K, O'Grady K, Toriumi D M. Biomechanical strength of human nasal septal lining: comparison of the constituent layers.  Laryngoscope. 2005;  115 1451-1453
    CrossrefPubMedGoogle Scholar
  • 11 Tardy E M. Rhinoplasty: The Art and Science. Philadelphia; WB Saunders 1997
    Google Scholar
  • 12 Orten S S, Hilger P A. Facial analysis of the rhinoplasty patient. In: Papel ID Facial Plastic and Reconstructive Surgery. New York; Thieme 2002: 361-368
    Google Scholar
  • 13 Toriumi D M, Ries W R. Innovative surgical management of the crooked nose.  Facial Plastic Clinics of North America. 1993;  1 63-78
    PubMedGoogle Scholar
  • 14 Toriumi D M. Structure approach in rhinoplasty.  Facial Plast Surg Clin North Am. 2002;  10 1-22
    CrossrefPubMedGoogle Scholar
  • 15 Goldfarb M, Gallups J M, Gerwin J M. Perforating osteotomies in rhinoplasty.  Arch Otolaryngol Head Neck Surg. 1999;  119 624-627
    PubMedGoogle Scholar
  • 16 Murray J A, Maran A G, Mackenzie I J, Raab G. Open v closed reduction of the fractured nose.  Arch Otolaryngol Head Neck Surg. 1984;  110 797-802
    PubMedGoogle Scholar
  • 17 Toriumi D M, Hecht D A. Skeletal modifications in rhinoplasty.  Facial Plastic Clinics of North America.. 2000;  8 413-432
    PubMedGoogle Scholar
  • 18 Toriumi D M. Management of the middle nasal vault.  Op Tech Plast Reconst Surg.. 1995;  2 16-30
    PubMedGoogle Scholar
  • 19 Toriumi D M. Subtotal reconstruction of the nasal septum: a preliminary report.  Laryngoscope. 1994;  104 906-913
    CrossrefPubMedGoogle Scholar
  • 20 Gunter J P, Rohrich R T. Management of the deviated nose: the importance of septal reconstruction.  Clin Plast Surg. 1988;  15 43-55
    PubMedGoogle Scholar
  • 21 Alsarraf R, Murakami C S. The saddle nose deformity.  Facial Plast Surg Clin North Am. 1999;  7 303-310
    PubMedGoogle Scholar
  • 22 Murakami C S, Guida R. Saddle nose deformity. In: Gates GA Current Therapy in Otolaryngology-Head and Neck Surgery. Hamilton, ON; BC Decker 1990: 168-171
    Google Scholar
  • 23 Kim D W, Shah A R, Toriumi D M. Concentric and eccentric carved costal cartilage: a comparison of warping.  Arch Facial Plast Surg. 2006;  8 42-46
    CrossrefPubMedGoogle Scholar

David W KimM.D. 

Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco

400 Parnassus Avenue A-730, San Francisco, CA 94143-0342

      >