2017-18 HSC Section 4 Green Book

Volume 139, Number 3 • Open Dorsal Approach to Rhinoplasty

Fig. 1. Anatomy of the nasal septum.

delineate the anterior septal angle in both primary and secondary rhinoplasty. This will allow for more uniform success in the creation and restoration of dorsal aesthetic lines, septal reduction and graft harvesting (if needed), correction of the deviated nose, maintenance and restoration of a functional airway, management of the nasal tip, and manipula- tion of the caudal septum in a predictable manner.

anterior border of the septum suspends the skin of the nose and the entire cartilaginous framework. 1,2 The anterior septal angle represents the anterior- most projecting point of the septum, and contrib- utes to nasal tip support, tip projection, nasal length, airway function, and internal nasal valve function (Fig. 2). The fibrous suspensory ligament of the nasal tip spans the septal angle, suspending the lower lat- eral cartilages. The position of the upper lateral car- tilages is indirectly affected by septal angle position through fibrous attachments to the cephalic margin of the lower lateral cartilages. 3 The goal of this article is to provide the reader with a detailed understanding of the anatomy that will guide the surgeon on how to approach and

ANATOMICAL APPROACHES

Primary Rhinoplasty The open dorsal approach to rhinoplasty is preferred to address the versatility of primary rhi- noplasty techniques that can be undertaken from

Fig. 2. Maneuvers possible from the anterior septal angle.

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