03 Larrabee Revision Rhinoplasty - ucsfcme.com
Transcript of 03 Larrabee Revision Rhinoplasty - ucsfcme.com
![Page 1: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/1.jpg)
1
Revision Rhinoplasty
Wayne F. Larrabee, Jr., M.D.
Clinical Professor
University of Washington
Seattle, Washington
Unilateral Spreader Graft
![Page 2: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/2.jpg)
2
![Page 3: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/3.jpg)
3
Deviated Nose- Unilateral Spreader Graft
Copyright restrictions may apply.
Andre, R. F. et al. Arch Facial Plast Surg 2004;6:36-40.
Spreader grafts
![Page 4: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/4.jpg)
4
Copyright restrictions may apply.
Schlosser, R. J. et al. Arch Facial Plast Surg 1999;1:105-110.
Schematic showing combined use of spreader grafts and flaring sutures to improve the cross-sectional area of the internal valve (from Park11)
Copyright restrictions may apply.
Schlosser, R. J. et al. Arch Facial Plast Surg 1999;1:105-110.
Placement of spreader grafts
![Page 5: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/5.jpg)
5
Non Anatomic Alar GraftOnlay Spreader Graft
from Auricular Concha
![Page 6: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/6.jpg)
6
![Page 7: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/7.jpg)
7
Right Onlay Spreader Graft, Alar Graft, Strut, Shield Tip Graft from
Auricular Cartilage
![Page 8: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/8.jpg)
8
Non Anatomic Lateral Crural Graft
Auricular Cartilage
![Page 9: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/9.jpg)
9
![Page 10: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/10.jpg)
10
Alar Batten Grafts
![Page 11: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/11.jpg)
11
![Page 12: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/12.jpg)
12
Right Spreader Graft, Right Alar Batten Graft, Columellar Strut
Alar Composite Graft
![Page 13: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/13.jpg)
13
Alar Retraction
![Page 14: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/14.jpg)
14
Composite Graft
![Page 15: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/15.jpg)
15
![Page 16: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/16.jpg)
16
Composite Graft, Shield Graft
![Page 17: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/17.jpg)
17
Extended Columellar Tip Graft
Copyright restrictions may apply.
Pastorek, N. J. et al. Arch Facial Plast Surg 2005;7:176-184.
Preoperative (A and C), 6-month postoperative (B and D), and intraoperative (E-L) views in the case of a 45-year-old woman who presented with a history of a rhinoplasty by another surgeon
![Page 18: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/18.jpg)
18
![Page 19: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/19.jpg)
19
![Page 20: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/20.jpg)
20
Tongue in Groove
Copyright restrictions may apply.
Kridel, R. W. H. et al. Arch Facial Plast Surg 1999;1:246-256.
The transfixion incision and retrograde dissection between the medial crura
![Page 21: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/21.jpg)
21
Copyright restrictions may apply.
Kridel, R. W. H. et al. Arch Facial Plast Surg 1999;1:246-256.
After the creation of the medial crural pocket, the medial crura are advanced onto the denuded caudal septum
Copyright restrictions may apply.
Kridel, R. W. H. et al. Arch Facial Plast Surg 1999;1:246-256.
Once the precise desired relationship between the medial crura and the septum is obtained, suture fixation is carried out
![Page 22: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/22.jpg)
22
Copyright restrictions may apply.
Kridel, R. W. H. et al. Arch Facial Plast Surg 1999;1:246-256.
The excess membranous septum is trimmed bilaterally after advancing the membrane anteriorly
Copyright restrictions may apply.
Kridel, R. W. H. et al. Arch Facial Plast Surg 1999;1:246-256.
The transfixion incision is closed with interrupted absorbable suture
![Page 23: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/23.jpg)
23
Copyright restrictions may apply.
Kridel, R. W. H. et al. Arch Facial Plast Surg 1999;1:246-256.
A, To correct a hanging columella, the medial crura are evenly advanced cephalically onto the denuded septal cartilage
Revision Rhinoplasty• Caudal septal extension
graft
• Extended spreader grafts
• Lateral crural replacement grafts (auricle)
• Columellar strut
• Cap graft (bruised septal cartilage)
• Temporalis fascia graft
• Osteotomies
![Page 24: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/24.jpg)
24
![Page 25: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/25.jpg)
25
![Page 26: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/26.jpg)
26
![Page 27: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/27.jpg)
27
![Page 28: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/28.jpg)
28
![Page 29: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/29.jpg)
29
![Page 30: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/30.jpg)
30
![Page 31: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/31.jpg)
31
![Page 32: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/32.jpg)
32
Ravaged Tip
• Auricular Cartilage Grafts
• Spreader Grafts
• Alar Batten Grafts
• Shield Grafts
![Page 33: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/33.jpg)
33
![Page 34: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/34.jpg)
34
Auricular Cartilage Grafts-Spreaders, Alar Batten, Shield
![Page 35: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/35.jpg)
35
Internal to External Osteotomy
![Page 36: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/36.jpg)
36
The Crooked Nose
• Septum
• Spreader Grafts
• Sequential Osteotomies
• Intermediate Osteotomies
• Camouflage
• Camouflage
• Camofluage.
“Like Opening a Book”
![Page 37: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/37.jpg)
37
![Page 38: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/38.jpg)
38
![Page 39: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/39.jpg)
39
![Page 40: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/40.jpg)
40
![Page 41: 03 Larrabee Revision Rhinoplasty - ucsfcme.com](https://reader030.fdocuments.us/reader030/viewer/2022012102/6169f8b511a7b741a34d66c0/html5/thumbnails/41.jpg)
41
The End