Date post: | 03-Jul-2015 |
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Health & Medicine |
Upload: | dr-zeeshan-ahmad-nmch |
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Nasal Septal ReconstructionDr Zeeshan AhmadM.S.(ENT,PGY1)
Department of ENT,
Nalanda Medical College, Patna.
Coming ahead………….
• Columellar Strut
• Caudal Septal Extension Graft
• Caudal Septal Replacement Graft
Facial Mathematics
• Relatively ideal proportions of different parts of face.
Columella
• The strip of skin running from the tip of the nose to the upper lip, which separates the nostrils.
Strut
• A structural element used to brace or strengthen a framework by resisting longitudinal compression STRUT
Columellar Strut
• A graft is placed into a pocket
dissected between the medial
crura.
• For minor caudal deviations.
• When base of nose is severely
deficient– Graft into notch in nasal spine of max.– Nasal spine into notch in graft post-inf.
Columellar Strut
• A graft is placed into a pocket dissected between the medial crura.
CLOSED
Columellar Strut
• A graft is placed into a pocket dissected between the medial crura.
OPEN
Caudal Septal Extension Graft (CSEG)
• Placed to augment the caudal septum.
• A straight segment of cartilage placed end to end or slightly overlapping the caudal septum.
• Shape and orientation of CSEG can be altered to provide different effects on tip position.
Nasal Tip Projection
• The nasal-tip projection is measured from the alar facial groove to the tip. It is appropriate at 50-60% of the nasal length. If > overprojected.
• The nasolabial angle should be 90-95° in men and 90-110° in women. If > then the tip is overrotated or vice versa (caudally rotated).
CSEG contd…..
• The caudal margin of CSEG must be vertical and in midline, otherwise tip will be deviated.
• The cephalic margin of the graft that overlaps the caudal septum should be beveled so that it does not obstruct the airway.
Caudal Septal Replacement Graft CSRG
• In severe deviations of caudal septum & in unstable caudal septum.
• Entire caudal aspect of septum is removed and replaced either with posterior part of septal cartilage or with costal cartilage.
CSRG contd...
• This technique is similar to columellar strut and CSEG.
• Difference is in removal of entire caudal septum.