Учебники / Rhinoplasty Dissection Manual Toriumi 1999
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Figure 6. A. Injection of local anesthetic along the lateral wall of the nose . B. Injection for lateral osteotomies.
REFERENCES
1. Beeson WH. The nasal septum. Oto laryn gol Clin North Am 1987 ;20:74 3-767 .
2.Kasperbauer JL, Facer GW, Kern EB. Reconstruct ive surger y of the nasal septum. In: Papal!D, Nachlas NE, eds. Facial pla stic and reconstructive slIrgely. Philadelphia: Mosby Year Book, 1992:337343.
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Septoplasty
NASAL DISSECTION: SEPTOPLASTY WITH CARTILAGE HARVEST
Hemitransfixion Incision with Anterior Septal Tunnels
1. |
Retract the colum ella with a small nasal speculum, multi toothed Brown-Adson forceps, |
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large two-prong hook, or another suitable instrument. This maneuver exposes the cau |
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dal margin of the septum (1,2). |
2. |
Make a hemitran sfixion incision along the caud al borde r of the cartilag inous septum |
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with a no. 15 blade or no. 15-C blade . In this exercise, a hemitransfixion incision ex |
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tendin g from the anteri or septal angle to the posterior septal angle is used to gain access |
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to the caudal septum. A Killian incision can be used if access to the caudal septum is not |
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necessary (Fig. IA). |
3. In rare cases, the nasal spine should be exposed . |
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4. |
With a no. 15 blade, small, sharp -pointed scissors, or other suitabl e instrument, incise |
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the perichondrium of the septum adjacent to the caudal septum on one side . |
5.Perform a subperichondrial dissection along the lower half of the septum to allow har vesting of septal cartilage. Do not extend this dissection too high, so that later in the dis
section a precise pocket tunnel can be made to place a spreader graft via an endon asal approach.
6. Repeat maneuver 5 on the oppo site side of the septum.
7. If the septum needs any shortening, now may be a good time to perform selective exci sion of the caud al aspect of the septum (Fig. IB-D). If rotat ion of the nasal tip is neces sary, a superiorly based triangle of caudal septum can be excised (Appendix F). For an obtuse nasolabial angle, the posterior septal angle can be trimmed . For a tension nose deformity (3) or hangin g-columella deformity, the entire caudal septum may need to be trimmed. Instead of resection, an overly long midlin e caud al septum can be sutured be tween the medi al crura to provide support, increa se projection, and set tip-rotation and alar-columellar relation.
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Figure 1. A: A hemitransfixion incision (short dotted lines) or a Killian incision (longer dotted lines) m be used to perform septoplasty. B: Conservative excision in an overlong septum of a thin wedge of ca dal septum to decrease columellar show or shorten the nose . C: Excision of a wedge of caudal septu with the base of the excised wedge anterior, for increased rotation. D: Excision of excess ive septum the posterior septal angle to decrease fullness of the nasolabial angle.
