Septorhinoplasty: Endoscopic Approach and Reinforcement of Nasal Support Line

Dhong, Eun Sang

Abstract

Septorhinoplasty in Asians is very challenging in terms of shortage of septal cartilage. Many cases in correction of dorsal and caudal septal deformities requires septal surgery including cartilaginous graft. Septoplasty is a well-known procedure which preserves majority of quadrangular cartilage, however, it is hardly adopted in Asians. The preoperative evaluation is accomplished using nasal endoscopy. The posterior and inferior chondrotomy for septal swinging-door procedure can be performed under endoscopic view. Also, the precise amount of bony spur and excessive cartilage can be excised. Endoscopy is also indispensable to precise hemostasis and turbinoplasty. Asian septoplasty is usually performed with maximal central submucous resection leaving critical L-strut, because surgeons need as much cartilages as possible for proper graft. In caudal septum, posterior septal angle loses its integrity after swinging-door procedure, and also loses the tip projection. This should be reinforced. Furthermore, in patients who have weak septal cartilage, key stone area needs to be reinforced by unilateral or bilateral spreader graft at the same time. Proper bilateral strut at the posterior septal angle continuous with spreader graft at rhinion may confirm the newly made solid L-strut. This solid caudal septum will be the new nasal base for the next tip plasty.