Rib Graft Rhinoplasty & Airway Reconstruction

 

Correction of a high deviated nasal septum often requires the placement of a spreader graft to straighten the dorsum. Rib grafts allow an ample amount of sold cartilage to keep the deviated nasal septum straight and buttress the internal nasal valve. When these maneuvers are performed, they improve the airway as well as improve the aesthetic contours of the nose. Tip defining sutures and lateral crural strut grafts can help provide improved tip definition.

Typically, the rhinoplasty consultation takes two sessions to make sure that the surgeon and the patient are on the same page with regard to the correct aesthetic look. I routinely ask patients to bring in photographs of noses that they like so that we can try to match as closely as possible their desired aesthetic look.

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Rhinoplasty & Airway Reconstruction

Rhinoplasty continues to be one of the most rewarding aspects of my practice. Not only is it rewarding to improve one's breathing, but also to improve the appearance and shape of one's nose. For complex rhinoplasty requiring maneuvers to increase tip projection or augment the radix, I prefer the use of rib graft and temporalis fascia.

I find that one needs ample cartilage for spreader grafts, columellar strut grafts, and lateral crural strut grafts to correct the common parenthesis deformity of the lower lateral cartilages. I am very thankful to have had great training from an excellent mentor.


Brian P. Dickinson, M.D.

Reduction of the Nasal Dorsum in Aesthetic Rhinoplasty & Airway Reconstruction.

Airway obstruction is a common problem. Airway obstruction can exacerbate allergies and can significantly impair a good night's sleep. Quite often, the surgical maneuvers that are used to correct the airway are also manauevers that can improve the appearance of the nose.

When patients undergo corrective airway surgery, often a deviated septum is straightened, the inferior turbinates are reduced, and the internal and or external nasal valves are supported. Post-operatively, patients are required to have nasal stents stay in the nose and an external splint placed on the nose if a fracture of the nasal bones is required. The nasal stents remain in placed for 5 to 7 days and the external splint remains in place for the same time period.


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Narrowing a Broad Nasal Dorsum in Aesthetic Rhinoplasty

Great care must be taken when adjusting a deviated septum and when narrowing the broad nasal dorsum in aesthetic rhinoplasty. It is important that the width of the nasal dorsum maintain appropriate proportion with the medial canthus of the eyes as well as the nasal base. This allows appropriate proportions and maintains the aesthetic balance of the nose.

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Aesthetic "Ethnic Rhinoplasty" & Septal Deviation.

The management of the ethnic rhinoplasty can be very challenging in the face of significant septal deviation and airway obstruction. Typically, if patients have had trauma to their nose they can damage both the nasal bones as well as the cartilage components of their nasal structures.

Often patients require a septoplasty to repair a significant deviation as well as spreader grafts to straighten and reinforce the septum. Occasionally an onlay graft of crushed cartilage can be used to define certain points of the nose to make it more aesthetically pleasing.

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Aesthetic Management of "Ethnic Rhinoplasty"

One of my favorite aspects of Plastic & Reconstructive Surgery is Rhinoplasty & Airway Surgery. And, within rhinoplasty, one of my favorite surgical challenges is the aesthetic management of the "Ethnic Rhinoplasty". The term "Ethnic" in these cases is used to denote an aesthetic terminology and proportion that differs from those angles and distances used to define a "Caucasian" nose.

People of different ethnicities often have noses with different characteristics. Often it is the desire of the patient to slightly alter the shape of their nose, but retain the ethnicity of their nose.  Valuable tools in these cases are cartilage, temporalis fascia, and careful osteotomies. However, the most valuable tools to an optimal outcome is the surgeon’s ability to listen to the patient's desires and goals.

In the above photograph the patient wanted to narrow the dorsum of the nose to facilitate definition on camera and on film. The patient however wished to maintain the alar base width. It is important when performing these procedures, to not make the nose “Ethnically Disproportionate”.


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Rhinoplasty & Airway Reconstruction

In nasal airway surgery, it is a great compliment when involuntarily the patient closes her mouth and breathes through her nose in the post operative photograph.

One of the more interesting observations in my patients is the ancillary findings on physical examination. Usually, I appreciate an unintentional open mouth smile in my post-operative photographs. However, for airway reconstructions, I am most pleased when the mouth is involuntarily closed. In these cases, I am convinced that the nasal airway is patent and the airway surgerywas successful.

At this point in my career, I have found that an optimal view of a deviated septum and it's correction with spreader grafts is best obtained via an open rhinoplasty incision. This approach allows separation of the lower lateral cartilages, visualization of the entire septum, and an optimal view through which to perform septoplasty. The harvested septum is then used for spreader grafts to support the internal nasal valve. I have been very happy with the use of septal cartilage for lateral crural strut grafs to stabilize the external nasal valve.

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