last among a three part presentation on rhinoplasty, presented at nalanda medical college, patna. on 14-2-13 in the department of otolaryngology(ENT)

1. Nasal Septal Reconstruction
Dr Zeeshan Ahmad
M.S.(ENT,PGY1)
Department of ENT,
Nalanda Medical College, Patna.

2. Coming ahead………….
• Columellar Strut
• Caudal Septal Extension Graft
• Caudal Septal Replacement Graft

4. Facial Mathematics
• Relatively ideal
proportions of
different parts of
face.

7. Columella
• The strip of
skin running
from the tip of
the nose to
the upper lip,
which
separates the
nostrils.

8. Strut
• A structural element used to brace or
strengthen a framework by resisting
longitudinal compression  STRUT

9. Columellar Strut
• A graft is placed into a pocket
dissected between the medial
crura.
• For minor caudal deviations.
• When base of nose is severely
deficient
– Graft into notch in nasal spine of max.
– Nasal spine into notch in graft post-inf.

10. Columellar Strut
• A graft is placed into a pocket
dissected between the medial crura.
C
L
O
S
E
D

11. Columellar Strut
• A graft is placed into a pocket
dissected between the medial crura.
O
P
E
N

12. Caudal Septal Extension Graft
(CSEG)
• Placed to augment the caudal septum.
• A straight segment of cartilage placed
end to end or slightly overlapping the
caudal septum.
• Shape and orientation of CSEG can be
altered to provide different effects on tip
position.

13. Nasal Tip Projection
• The nasal-tip projection is measured
from the alar facial groove to the tip. It
is appropriate at 50-60% of the nasal
length. If > overprojected.
• The nasolabial angle should be 90-95°
in men and 90-110° in women. If > then
the tip is overrotated or vice versa
(caudally rotated).

14. CSEG contd…..
• The caudal margin of CSEG must be
vertical and in midline, otherwise tip will
be deviated.
• The cephalic margin of the graft that
overlaps the caudal septum should be
beveled so that it does not obstruct the
airway.

22. Caudal Septal Replacement Graft
CSRG
• In severe deviations of caudal septum
& in unstable caudal septum.
• Entire caudal aspect of septum is
removed and replaced either with
posterior part of septal cartilage or with
costal cartilage.

23. CSRG contd...
• This technique is similar
to columellar strut and
CSEG.
• Difference is in removal
of entire caudal septum.