Tailoring Nasal Splints to Optimize Rhinoplasty Results

Abstract

Sir: No rhinoplasty surgeon would deny the contributions of nasal splinting in this challenging surgery. It can help to stabilize structures, thus reducing edema and improving remodeling appearances. Although many masters in this field have emphasized this step and introduced commodities off the shelf, better results could be achieved if nasal splints could be tailored to fit different cases. Over the past 2 years, partly because of economic considerations, we have chosen to fashion nasal splints ourselves for our patients. This has proved to be a simple and effective tip that is worth sharing. In the preparation process, empty alloy cans were collected. We selected those that were stronger than aluminum cola cans, softer than lead pots, with good flexibility, and with a smooth surface. The entire body was cut into one metal plate and then thoroughly cleaned and sterilized. A broad, cloth tape was placed on one side of the metal plate for standby. Then, a reel of double-sided adhesive foam was prepared—the senior author used items found easily in supermarkets and hardware stores, including a sewing scissors, pliers, ballpoint pen, and ruler in the operating room for tailoring (Fig. 1).Fig. 1.: Materials and splints.At the end of each rhinoplasty operation, after all incisions have been closed and before the patient has left the operating room, 5 minutes is spent tailoring the splint. First, the distance between the radix point and the anterior angle of the septum to be the height of an isosceles trapezoid-shaped splint is measured. Then, each projection (upper projection and lower projection) and the width between two dorsum aesthetic lines (upper width and lower width) are measured carefully on these two points to plan the upper and lower edges of the trapezoid. Finally, we can draw an isosceles trapezoid on the cloth tape/metal plate composite with its bottom edge being as long as doubled lower projection plus lower width; the upper edge is doubled upper projection plus upper width and its height equal to the height of an isosceles trapezoid-shaped splint (Fig. 2). The scissors is used to cut the trapezoid off the plate and blunt four angles into an arc form, making sure that there is no barb on any of the edges. With the help of a long straight pliers, it can easily be angled along the dorsum aesthetic lines on the splint. After trying it on the patient's nose and determining that it is satisfactory, we can fix it on the patient's nose with the double-sided adhesive foam to finish the work.Fig. 2.: Splint design: UP, upper projection; UW, upper width; LP, lower projection; LW, lower width; H, height of an isosceles trapezoid-shaped splint.In our experience, the tailoring splint can replace those commodities, be used repeatedly on the same patient, and be adjusted at the surgeon's will. It costs only 5 minutes and almost no money to make a new one whenever we need it. We can even teach patients to do it themselves in the kitchen, which is often helpful for nonlocal patients. Generally, tailoring splints can save money and time, save patients and surgeons sometimes, and always save the earth. Zhanqiang Li, M.D. Yongxue Xie, M.D. Qinjian Peng, M.D. Lin Liu, M.D. Bo Yu, M.D. Beijing Huangsi Aesthetical Surgery Hospital Beijing, People's Republic of China