Anatomical approach to rhinoplasty UTMB （为鼻整形术UTMB解剖的方法）.PDF

Anatomical Approach to Rhinoplasty Herve LeBoeuf, MD Faculty Advisor: Karen Calhoun, MD The University of Texas Medical Branch Department of Otolaryngology Grand Rounds Presentation January 2001 Which Incision ?? Transfixion/Hemitransfixion  Caudal septum, medial crura, nasal spine  Just caudal to septum  Follows medial crura to flared ends  Extend to floor for tip projection access  Hemi- is unilateral only – Avoids disruption of tip support – Poorer access, ? Asymmetric healing Intercartilaginous Incision  Access to the tip and mid-nose  Incision intranasal, between the ULC/LLC  Begin medially as transfixion extension  Continue entire length of LLC  Avoid transecting the lateral end of the LLC Intracartilaginous Incision  Access to the tip and mid-nose  Incise through vestibular mucosa +/- lower lateral cartilage  Similar to intercartilaginous, but 3-5mm caudal to the cephalic end of LLC – This is caudal to the nasal valve – Decreases risk of nasal obstruction (avoids scar contracture of the valve) Rim and Marginal Incisions  Made parallel to the caudal borders of LLC (cephalic border of nasal vibrissae)  Endonasal approach – More access to modify LLC – Combined with intercartilaginous incision to create pedicled or bipedicled flap of cartilage and mucoperichondrium  Always used in external approach – Extend to lateral end of LLC – In continuity with the transfixion incision Transcollumellar  External approach  Crosses collumella just above flared ends of the medial crura  If too close to the lip, “dip” deformity – No cartilage support to counteract tension generated by the healing skin  Notching at the midline –