Rhinoplasty - The Nasoseptal L Strut скачать в хорошем качестве

Rhinoplasty - The Nasoseptal L Strut

http://drkimfacialplastics.com/ This is Dr David W Kim. Todays video blog is about the Nasoseptal L Strut which is part of the nasal septum and how this is the foundation for aesthetic and functional rhinoplasty. I recently had the privilege of speaking at the 6th bisenial Milan Rhinoplasty course in Italy. We united several rhinoplasty experts from around the world and I had the privilege of presenting on this topic. The septum is the partition which separates the two sides of the nose. It serves as more than a partition. It serves as the foundation of the nose and has lots of implications on rhinoplasty. If the septum is too high in the direction along the bridge, it creates a bump. If the septum is crooked along the front or along the bridge the nose can be crooked and if the septum is deviated internally, it creates breathing problems. The septum sits at the top of the architectural hierarchy of the nose. Because the septum is the foundation of the nose, it is interconnected very intimately with the nasal bones. These two structures have a significant bearing on the cartilage structures on the lower two thirds of the nose. So there is a saying in rhinoplasty "where the septum goes, so goes the nose". This can be seen in these two patients, the bottom of the septum is crooked, causing obstruction and deviation. The septum is over developed on the bridge of this patient's nose, causing a bump. The septum clearly has several roles inside the nose. The foundation, the partition, the anchor, the donor source, the bridge, the shock absorber. The L Strut segment of the septum refers to this section. This is a side view of the septum, an illustration with the rest of the nose removed. This portion along the bridge and this portion between the nostrils serves as the foundation of the nose. When we do traditional septoplasty we remove this section of the septum, behind the so called L strut. However, manipulation and modification of the L strut is necessary to fix certain types of problems in the nose. For example, in a patient like this, the L strut is a little crooked to the left side. Septal cartilage can be placed from a graft and inserted into the section of deficiency along the L strut, allowing the nose to become straight. This is an example of a problem that we will see if a bump is removed from a bridge. When this happens the septum is disconnected from the upper cartilages, creating a situation where pinching might occur. The Spreader Grafts which is a technique of placing cartilages between the gap from the front end of the septum and these upper cartilages. This technique can be used to prevent this type of pinching. Its also a useful technique to straighten the nose. Again a Spreader graft was placed, with the appropriate thickness, on the depressed portion of the middle part of this gentleman's nose to create this overall straightening. Sometimes along the front edge, if the septum is deviated, the septum can be released from its attachments and repositioned to a straighter orientation. This can be seen in this young women, who had a deviation of her septum towards her left side. Straightening it allows us to improve the overall orientation and breathing of the nose. Cartilage was also placed in the middle portion of the nose to allow the L strut portion and the septum on the bridge to be straighter as well as on the base. If the septum is severely deviated a portion of the septum may actually need to be removed and replaced with a straight segment. This was the case in this gentleman. The bottom of the septum was severely deviated to the left, causing the tip to be deviated to that direction. As well as obstruction, he also had a big bump on the bridge where the septum was over developed. Surgically, I repositioned the septum along the front, I added cartilage to the right side of the bridge and I reduced the cartilage from the top, allowing his nose to be straighter, allowing his nose to breath more effectively and allowing the profile to be more refined. Sometimes if the septum is severely deviated, the majority of the cartilage needs to be removed and replaced. When the septum is completely missing or very compromised a very large graft, using rib cartilage may be necessary to allow the septum to be reconstructed, the nose to be refined and repositioned. The septum is clearly and important role for rhinoplasty and skillful manipulation can lead to good results.