tailieunhanh - Rhinoplasty Dissection Manual - part 7

Bảng rhinoplasty (KL) cho thấy rằng bệnh nhân này đã trải qua plasty septo với việc thu hoạch sụn. Cô trải qua bảo thủ cắt xoay thai. Cô nhận được một lar columel thanh chống, plumping ghép, ghép miếng cẩn ngoài lưng, ghép rải, và thuộc về cánh trở nên mập ghép. | 108 RHINOPLASTY DISSECTION MANUAL Surgery of the Nasal Tip 109 Figure 20 continued. The rhinoplasty worksheet K-L illustrates that this patient underwent septoplasty with cartilage harvest. She underwent conservative cephalic resection. She received a columel-lar strut plumping grafts dorsal onlay grafts spreader grafts and alar batten grafts. Preoperative M o Q S and postoperative N p R T photographs are seen here. Note the improvement in the nasal valve best seen on base view. Lateral Crural Grafts Lateral crural grafts are anatomic grafts that replace excessively reduced or deformed lateral crura. These grafts are shaped like lateral crura and measure approximately 5 mm in vertical height. Auricular cartilage has the ideal curvature for lateral crural grafts. The grafts are sutured to the vestibular skin and medlial or intermediate crura. Care is taken so the caudal margins of the grafts are placed symmeưically otherwise there may be asymmetry of the alar rims. Grafts that are too large or curved may create a bulbous tip 2 Fig. 21 . Figure 21. Intraoperative photograph illustrating lateral crural grafts and a shield graft. The grafts are sutured to the vestibular skin and medial or intermediate crura. PEARLS Complete Strip Although many surgeons perform cephalic trim of the lateral Crttra as a routine maneuver during rhinoplasty some patients have flat or concave lateral crura that do not contribute to tip buibosity. Many of these patients do not need to undergo cephalic trim of the lateral crura. Cephalic trim should be performed when there is fullness bulbosity in the supratip or supraalar region due to protrusion of the cephalic margin of the lateral crura. The surgeon should leave 7 mm to 9 mm of lateral crus. This determination is made on a patient-to-patient basis. The strength of the lateral crura and alar sidewalls should be considered. With strong cartilages more cartilage can be excised and with weak cartilages more cartilage should be preserved. .