Embed Size (px)
Citation preview
1
Revision Rhinoplasty
Wayne F. Larrabee, Jr., M.D.
Clinical Professor
University of Washington
Seattle, Washington
Unilateral Spreader Graft
2
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
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
5
Non Anatomic Alar GraftOnlay Spreader Graft
from Auricular Concha
6
7
Right Onlay Spreader Graft, Alar Graft, Strut, Shield Tip Graft from
Auricular Cartilage
8
Non Anatomic Lateral Crural Graft
Auricular Cartilage
9
10
Alar Batten Grafts
11
12
Right Spreader Graft, Right Alar Batten Graft, Columellar Strut
Alar Composite Graft
13
Alar Retraction
14
Composite Graft
15
16
Composite Graft, Shield Graft
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
18
19
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
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
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
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
24
25
26
27
28
29
30
31
32
Ravaged Tip
• Auricular Cartilage Grafts
• Spreader Grafts
• Alar Batten Grafts
• Shield Grafts
33
34
Auricular Cartilage Grafts-Spreaders, Alar Batten, Shield
35
Internal to External Osteotomy
36
The Crooked Nose
• Septum
• Spreader Grafts
• Sequential Osteotomies
• Intermediate Osteotomies
• Camouflage
• Camouflage
• Camofluage.
“Like Opening a Book”
37
38
39
40
41
The End
