2017-18 HSC Section 4 Green Book

Plastic and Reconstructive Surgery • March 2017

Fig. 5. Preoperative ( left ) and postoperative ( right ) photographs demonstrating a patient who underwent a dorsal hump reduction. Identification of the anterior septal angle affords access to the nasal dorsum for dorsal hump reduction.

The anterior septal angle serves as a conduit to bet- ter diagnose and treat this preventable deformity in both primary and secondary rhinoplasty (Fig. 4). Caudal Manipulation of the caudal components of the nose affects both functional and aesthetic outcomes in rhinoplasty, such as the nasal airway, columellar width, tip projection, and tip rotation. Once the anterior septal angle is identified, dissec- tion can reliably proceed in the caudal direction to accomplish desired maneuvers such as medial cru- ral repositioning, placement of columellar strut

grafts, 15 caudal septal manipulation, 16 and depres- sor septi muscle transection (Figs. 5 and 6). 17

DISCUSSION The anterior septal angle represents the critical cornerstone on which every open dorsal approach to rhinoplasty should begin. Once this key anatomical point is identified, dissection can be reliably performed, leading to ideal aesthetic and functional manipulation of the nose by means of one of the four gateways discussed for both pri- mary and secondary rhinoplasty.

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