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Rhinoplasty

- Suture technique Graft-

ENT R2

Facial landmark

Basic anatomy

Goodes Ration for Nasal Projection


alar

crease to TDP
dorsal length
= 0.55-0.60

projection:

length
= 3:4:5

height:

Spreader graft ( )

Spreader graft ( )
:



(For middle valut rehabililtation
Lateralize the upper lateral cartilarge but also strengthen
the middle valut to resist the inward motion on inspiration)

Spreader graft ( )


nasal valve ,
browtip aesthetic line
V invertedVdeformity


spreader graft
.

Spreader graft ( )

( Septal cartilage, auricular


cartilage)
5mm, (
20mm ),
.
, 5-0
4-0 PDS horizontal
mattress suture
.

.


( nasal tip surgery )

: tip projection .
: tip rotation .

Tripod theory

Tip modification technique


Classification
Cartilage sculpturing
Excision: Volume reduction of lateral crus
Complete strip
Incomplete strip
Incision
Suture technique
Interdomal suture
Transdomal suture
Graft
Columellar strut
Shield graft
Onlay graft

Tip rotation
(Cephalic

Cephalic trim)

resection, Complete strip,

Tip rotation

(Incomplete or Interrupted strip)

Increase tip projection

Plumping graft
Lat. Crural steal
Premaxillary graft
Septocolumellar sutures
Columellar strut
Caudal extension graft
Shield graft
On-lay graft
Interdomal suture

Suture technique
Transdomal
Interdomal
Intercrural
Lateral

suture

suture
suture

crural spanning suture

Columellar-septal

suture

Interdomal suture ; tip


cephalic resection dome
Dome horizontal mattress suture .
suture dome ,
dome concave
.
Transdomal suture ; dome
suture interdomal distance
bifid tip refining
. Projection
cephalic resection
interdomal suture . Tip definig
point light reflex middle
crus 60 suture
tip
suture .

Upper and lower cartilage suture ;


cephalic rotation
.
Lateral crural steal technique ;

Suture technique

Interdormal suture

Transdomal suture

Interdormal suture

Transdomal suture

Columellar strut

External approach medial crus



suture.
Endonasal approach marginal
incision medial crus dissection
. suture
.
shield graft cap graft
projection rotation .

Shield graft


medial crus suture.
Graft
tip defining point
.
graft 6-8mm tip
.
infratip
double break .
Tip projection rotation .
graft cephalic
rotation .

Shield graft
-
-
-6-8mm, TDP

Cap graft, Endonasal onlay graft

Cap graft ; Rotation projection


tip defining point
onlay graft.
Endonasal onlay graft ; external approach
dome subcutaneous pocket

graft . Columella
strut medial curs
dome projection
rotation .

Cap graft, on-lay graft


TDP 6-8mm
, ,
strut

graft

Plumping

-Medial crus
-