W. Russell Ries MD, and Harry V. Wright MD

Department of Otolaryngology/Head & Neck Surgery, Division of Facial Plastic & Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, Tennessee

A Novel Suction Elevator for Facial Plastic Surgery

Vanderbilt Bill Wilkerson Center

Introduction:Nasal septoplasty is the third most common head and neck procedure in the US. The correction of nasal septaldeviation requires delicate surgical maneuvers that aim to expose the areas of anatomic deviation.

In 1902 Freer advocated “violence to overcome the resiliency of the septum…” 1 in the correction of septaldeformity. Modern approaches, however, respect the septum as the determinant of nasal shape and contour.2

As our understanding of nasal anatomic nuance and physiologic properties improves, surgical instrumentation must also evolve to meet the demands of the surgeon.

We recognized deficiencies in several commonly-used suction elevators. We propose a modified suction elevator specifically designed to optimize visualization during flap elevation and minimize the risk of trauma to the flap.

References:1.Freer OT: The correction of

deflections of the nasal septum with a minimum of traumatism, JAMA 38:636, 1902.

2.Godley FA. Nasal septalanatomy and its importance in septal reconstruction. Ear Nose Throat J 76:498, 1997.

Figure 1. The Ries suction elevator

Results:Suction elevators that are currently available are the Haberman, Lerault, and Gorney (above) models.

• The Haberman elevator to large for many techniques in facial surgery and lacks a finger cut-off, preventing surgeon from fine-tuning the strength of the suction.

• Gorney and Lerault suction elevators are more amenable to delicate facial surgery, however we found the through-and-through suction port flawed. -- suction ports increase of the airstream velocity and an attendant decrease in the relative air pressure on both (convex and concave) faces of the elevator. This tends to collapse the opposing tissues toward the elevator via Bernoulli effect, limiting visualization and increasing the risk of trauma to the flap.

• The hollow tip of the Gorney is difficult to sterilize.

Conclusions:The Ries suction elevator (Fig. 1) is designed to address the drawbacks of commonly available suction elevators. size is conducive to facial surgery finger cut-off for modulation of suction strength solid tip to prevent contamination the flapward (convex) surface of the Ries

elevator is not ported for suction. This prevents the flap from being drawn towards the elevator and collapsing the plane of dissection, thereby optimizing visualization and minimizing the risk of flap trauma

While the Ries suction elevator was specifically developed for use in nasal septoplasty, the senior author (W.R.R.) has several years of experience using it for all manner of facial plastic surgery.