Учебники / Rhinoplasty Dissection Manual Toriumi 1999

Now apply domal/transdornal suture s as outlined .

Place Individual Horizontal Mattress Domal Sutures

For domal sutures (Fig . 9), a mattres s suture of 5-0 polydiox anone suture (PDS) or oth appropriate suture is passed through each dome, and the knot of each mattre ss suture is ti between the domes. As the sutures are secured, narrowing of the tip is accomplished. interdomal suture sets the width between the domes. If stiff nasal-tip cartilages are e countered, the surgeon should use 5-0 clear nylon instead of PDS (4-6).

Place Single Transdomal Suture

Alternatively, a single transdomal suture that traver ses both domes may be placed, in li of two individual domal sutures and an interdomal suture (Fig . 10) (1-3) . The caudal pa should be slightly longer than the cephalic pass of the mattress suture . When the mattre suture is placed in this fashion, the caudal edge will tend to lead the cephalic edge as t suture is tightened. This creates a more favorable tip-supratip relation . If the cephalic ed leads the caudal edge of the lateral crus despite proper placement of the domal suture, small cephalic wedge of the cartilage may be excised and the edges sutured, which repo tions the cephalic edge lower in relation to the caudal edge (Fig. 11).

A,B

Figure 9. Individual horizontal mattress domal sutures. The caudal pass is slightly longer than the cephalic pass of the mattress suture . As the sutures are secured, narrowing of the tip is accomplished. An interdomal suture is placed between the two domes, securing the interdomal distance.