Apaydin Fazil
Department of Otorhinolaryngology, Ege University Medical Faculty, Bornova, İzmir, Turkey.
Facial Plast Surg. 2016 Aug;32(4):351-60. doi: 10.1055/s-0036-1585423. Epub 2016 Aug 5.
During rhinoplasty, the most stressful areas of the nasal cartilaginous septum are at the key area and anterior nasal spine. A stable fixation of the caudal septum to respond to these stresses is of utmost importance. The prerequisite for a successful fixation is a well-prepared recipient bed for caudal septum and suture fixation. The bed can be opened by using scissors, osteotome, or powered instrumentation. Simple or multiple sutures passing from the bone and/or surrounding soft tissues are used for fixation. At the key area, if a complete separation of the L-strut occurs, it should be sutured to nasal bones and upper lateral cartilages. The septum should be supported by splinting spreader grafts to increase stability. To prevent dorsal irregularities, a dorsal onlay camouflage graft should be used. The best way is to take cautions to prevent such a mishap. That is why a dorsal segment of 12 to 15 mm should be preserved, at least at the key area, and part of the mucoperichondrium should stay attached to the septum.
在鼻整形术中，鼻中隔软骨最受力的区域位于关键区域和鼻前棘。鼻中隔尾端的稳定固定以应对这些压力至关重要。成功固定的前提是为鼻中隔尾端准备好合适的受区床并进行缝合固定。可以使用剪刀、骨凿或动力器械打开受区床。通过骨和/或周围软组织的简单或多重缝合用于固定。在关键区域，如果L形支柱完全分离，应将其缝合至鼻骨和上外侧软骨。应使用撑开移植片夹板支撑鼻中隔以增加稳定性。为防止鼻背不规则，应使用鼻背覆盖伪装移植片。最好的方法是小心预防此类意外。这就是为什么至少在关键区域应保留12至15毫米的鼻背段，并且部分粘软骨膜应附着于鼻中隔。
