J Rhinol.  2022 Mar;29(1):1-12. 10.18787/jr.2021.00390.

Dissection Manual for Open Rhinoseptoplasty in a Silicone Nose Model

• Lee KI
• Won TB
• Hyun S
• Song H
• Jang YJ
• Choi JY
• Hong SN
• Kim HY
• Kim JS
• Kim SW
• The Korean Academy of Facial Plastic and Reconstructive Surgery

• KMID: 2528313
• DOI: http://doi.org/10.18787/jr.2021.00390

Abstract

Open rhinoseptoplasty has been widely performed in the field of otorhinolaryngology. However, from the perspective of beginners, rhinoseptoplasty is a hard-to-learn surgery that involves a relatively steep learning curve. Therefore, practical guidance is essential to enhance the skills needed for excellent surgical outcomes. Here, we provide a step-wise dissection manual using a commercialized silicone nose model designed for rhinoseptoplasty. The contents include general approaches with regard to transcolumellar inverted V incision, flap elevation, osteotomy, septoplasty, modification of the lower lateral cartilage for tip surgery, and dorsal augmentation using silicone implants. In addition, we introduce novel techniques such as dorsal augmentation using a ready-made mold with tissue glue applied to diced cartilage and polycaprolactone mesh for rhinoseptoplasty. The present study also provides photos of individual surgical procedures using a silicone nose model for actual guidance. The authors expect that this manual will help beginning rhinoseptoplasty surgeons improve their confidence.

Keyword

Rhinoplasty; Dissection; Methods; Nose; Silicones

Figure

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  Fig. 1. Demonstrative photos of a silicone nose model (Simulare Medical Corp., Ontario, Canada). A: Frontal view. B: Lateral view. C: Separated view between a facial part for the support and a nasal part for the operation. D: Posterior view.

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  Fig. 2. Demonstrative photos of incision using a silicone nose model. A: Marking for inverted V incision. B: Mid-columellar incision. C: Marginal incision along the caudal margin of lower lateral cartilage. D: Lateral columellar incision connected with previous marginal incision and mid-columellar incision.

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  Fig. 3. Demonstrative photos of flap elevation and septal cartilage harvest using a silicone nose model. A: Supraperichondrial dissection. B: Subperiosteal dissection. C: Dissection of the membranous septum. D: Endoscopic view of septal cartilage harvest using a 0-degree rigid telescope.

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  Fig. 4. Demonstrative photos of humpectomy using a silicone nose model. A: Design of osteotomy. B: En-bloc resection of a cartilaginous and bony hump. C: Rasping. D: Division of upper lateral cartilage and nasal septum.

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  Fig. 5. Demonstrative photos of medial and lateral osteotomy using a silicone nose model. A: Medial osteotomy. B: Intra-nasal view of lateral osteotomy using a 0-degree rigid telescope. C: Outside view of the lateral osteotomy. D: Outside view of percutaneous osteotomy using 2 mm osteotome.

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  Fig. 6. Demonstrative photos of suture technique using a silicone nose model. A: Transdomal suture. B: Interdomal suture.

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  Fig. 7. Demonstrative photos of cartilage grafting using a silicone nose model. A: Onlay graft. B: Shield graft. C: Spreader graft. D: Columellar strut. E: Septal extension graft (caudal septal extension type). F: Septal extension graft (extended spreader type).

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  Fig. 8. Representative photos of dorsal augmentation with a silicone implant. A: Carving of a silicone implant. B: Insertion of a silicone implant into a dorsal pocket.

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  Fig. 9. Demonstrative photos of dorsal augmentation with diced cartilage. A: Dicing of cartilage. B: Molding with tissue glue using a commercially available mold (Jang Cartilage Mold, Nextcore Co., Ltd., Ulsan, Republic of Korea).

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  Fig. 10. Demonstrative photos of alar base resection. A: Nostril sill excision. B: Alar wedge resection.

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  Fig. 11. Representative photos of PCL mesh. A: Demonstrative picture. B: Surgical view of the septal extension graft combined with PCL mesh bilaterally (From Kim, et al. Laryngoscope 2020;130(7):1680-5 [28]., with permission of Wiley). PCL, polycarprolactone.

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