Nasal Septal ReconstructionDr Zeeshan AhmadM.S.(ENT,PGY1)

Department of ENT,

Nalanda Medical College, Patna.

Coming ahead………….

• Columellar Strut

• Caudal Septal Extension Graft

• Caudal Septal Replacement Graft

Facial Mathematics

• Relatively ideal proportions of different parts of face.

Columella

• The strip of skin running from the tip of the nose to the upper lip, which separates the nostrils.

Strut

• A structural element used to brace or strengthen a framework by resisting longitudinal compression STRUT

Columellar Strut

• A graft is placed into a pocket

dissected between the medial

crura.

• For minor caudal deviations.

• When base of nose is severely

deficient– Graft into notch in nasal spine of max.– Nasal spine into notch in graft post-inf.

Columellar Strut

• A graft is placed into a pocket dissected between the medial crura.

CLOSED

Columellar Strut

• A graft is placed into a pocket dissected between the medial crura.

OPEN

Caudal Septal Extension Graft (CSEG)

• Placed to augment the caudal septum.

• A straight segment of cartilage placed end to end or slightly overlapping the caudal septum.

• Shape and orientation of CSEG can be altered to provide different effects on tip position.

Nasal Tip Projection

• The nasal-tip projection is measured from the alar facial groove to the tip. It is appropriate at 50-60% of the nasal length. If > overprojected.

• The nasolabial angle should be 90-95° in men and 90-110° in women. If > then the tip is overrotated or vice versa (caudally rotated).

CSEG contd…..

• The caudal margin of CSEG must be vertical and in midline, otherwise tip will be deviated.

• The cephalic margin of the graft that overlaps the caudal septum should be beveled so that it does not obstruct the airway.

Caudal Septal Replacement Graft CSRG

• In severe deviations of caudal septum & in unstable caudal septum.

• Entire caudal aspect of septum is removed and replaced either with posterior part of septal cartilage or with costal cartilage.

CSRG contd...

• This technique is similar to columellar strut and CSEG.

• Difference is in removal of entire caudal septum.