Yên xe mũi biến dạng nghiêm trọng có thể được điều trị bằng cách sử dụng sụn sườn tự sinh (8,9 Harvest xương sườn escribed sau. Ghép xương sườn được chạm khắc vào một ghép lưng và một thanh chống columell, interdigitated để tái tạo lại nguyên vẹn L-thanh chống (Hình 6) | Other Maneuvers 129 Figure 5 continued. The severely deviated component U-W is removed along with posterior septum X . The deviated septum is replaced with straight septal cartilage Y-Z harvested posteriorly. A tip graft also was applied AA . 130 RHINOPLASTY DISSECTION MANUAL RIB CARTILAGE GRAFT RECONSTRUCTION OF SADDLE DEFORMITY INTEGRATED DORSAL GRAFT COLUMELLAR STRUT The severe saddle-nose deformity may be treated by using autogenous rib cartilage 8 9 . Harvest of rib is escribed later. The rib graft is carved into a dorsal graft and a colutnellar strut which are interdigitated to recreate an intact L-strut Fig. 6 . This type of structural reconstruction is particularly useful when there is complete loss of septal support. If an intact nasal septal L-strut is present onlay dorsal grafting will be sufficient to correct the deformity. Great care must be taken to adhere to the principle of balanced cross-sectional carving to minimize the risk of graft warping. Once in position the domes can be sutured over the graft with a transdomal suture. An external rhinoplasty approach allows exposure for facile placement of these grafts. A tip graft allows improved tip projection and definition. Figure 6. A B Severe saddle-nose deformity. Rib graft is fashioned into a columellar strut secured to the medial crura and a dorsal onlay graft that interdigitates with the columellar strut. C-EE slides Preoperative C-F photographs of a patient with a severe saddle-nose deformity. She underwent application of an iliac bone graft to her nasal dorsum in the past. Lack of an intact L-strut and inadequate middle vault support resulted in descent of the graft airway obstruction and referral to our office for reconstruction. Base view reveals the bone graft in the left nostril and a widened columellar scar. other Maneuvers 131 D Figures .
