A Simple Method of Cartilage Ekartation During a Nasal Dorsal Reduction.

Abstract

To the Editor, Nasal dorsal reduction is a frequently used manoeuvre in primary rhinoplasty [1, 2]. This operation involves the reduction of the nasal dorsal bone by means of chisels, rasps, power or ultrasound assisted instruments following the reduction of the dorsal component of the septal and upper lateral cartilages (ULC) [2–4]. One important point to be considered at this stage, no matter what technique or instrument is used, is to avoid damaging soft tissues or cartilages while applying osteotomy or rasping. In the event of damage, internal nasal valve functions may be impaired due to a cartilage–bone separation that may occur in the keystone area. Anatomical problems such as inverted V or saddle nose may also occur in cases where the dorsal part of the ULC is subjected to trauma and the dorsal line cannot be ensured in the desired way thereby [2–5]. In rhinoplasty, while the ULC reduction procedure is classically made through cartilage excision from the dorsal part of the cartilage, turn-down flap techniques with more minimal resection have gained currency over the recent times [4, 5]. In the classical method, as the ULC is excised as low as the septum, there is relatively a lower risk of being damaged during rasping. In the turn-down flap technique, the ULC bilaterally remain higher than the bone and cartilage septum after dorsal hump reduction and the risk of its being exposed to a trauma during rasping increases. Despite the fact that the ULC tend to turn inferiorly and posteriorly as a result of their own resistance after separation from the septum, this turning effect may sometimes not occur adequately and there may be a need for additional manipulation [4]. While certain retractors or forceps can be used to this end, directing the angle of the rasp towards the bone roof and drawing it away from the soft tissue can be listed among the methods used in practice [5]. In our technique, over folding is applied after the ULC are separated from the septum, the skin is entered on one side with a dental needle tip to position the septum by passing tangent to the upper boundary of the ULC, and the cartilages by exiting through the ULC and the skin of the other side (Fig. 1). Fixation is ensured at two points, namely, the cephalic and caudal boundaries of the cartilages. If a rasp is to be used, the rasp can easily be directed to any angle. A secure fixation is ensured as the tip of the injector passes through the skin and no slide or dislocation being encountered in the cartilages during dorsal reduction with chisel or rasping (Fig. 2). No damage occurs on the skin or the cartilage because a dental needle tip is used. When the depth of the dorsal hump reduction is adjusted, turning down the ULC and fixing them at the desired position temporarily with a needle tip significantly contributes to the adjustment of the reduction. Despite the fact that fixing the ULC to the septum with a needle tip and & Emin Kapi eminkapi@gmail.com