Nasal septal deformity is a central feature of the crooked nose, contributing to functional and aesthetic problems. Straightening of the septum often requires resection, scoring, or incision of the septum—maneuvers that inevitably weaken the cartilaginous dorsal and caudal L-shaped struts, which together are known as the L-strut. Compromise of this L-strut predisposes to septal buckling, recurrent deviation, and saddle nose deformity. We describe our experience with the oblique septal crossbar, a structural graft that allows biomechanically sound anterior septal angle reconstruction during septorhinoplasty. The technique improves dorsal septal support and facilitates correction of the crooked nose. The open septorhinoplasty approach and swinging door maneuver are followed by placement of a diagonally oriented crossbar graft, obtained from cartilage or the perpendicular plate. The approach allows consistent midline correction and buttressing of the nasal dorsum, with no complications to date.
Structural grafting resists contractile forces of healing to prevent buckling of the nasal dorsum. A, Spreader grafts: the dorsal portion of the septal L-shaped strut is strengthened, but grafts do not directly counter downward forces. B, Oblique septal crossbar: the graft serves as a buttress to resist buckling of the nasal dorsum, while also straightening the anterior septal angle.
Spreader crossbar graft. Staggered, full-thickness incisions are created along the L-shaped strut, and a cartilage graft is used to splint the bent dorsal septum toward the midline (reproduced with permission from Boccieri and Pascali14).
Oblique septal crossbar graft. A, Preoperative frontal view of deviated septum and canted nasal framework. B, Preoperative helicopter view. C, Postoperative frontal view after reconstruction with oblique septal crossbar. D, Postoperative helicopter view.
Variations on placement of oblique septal crossbar graft. A, Lateral view. B, Oblique view.
Intraoperative views of oblique septal crossbar. A, Oblique view of graft in position. B, Frontal view. C, Graft may be parachuted into position for more posterior positioning. D, Graft in position.
Clinical example, patient 1. A, Preoperative frontal view. B, Preoperative base view. C, Postoperative frontal view. D, Postoperative base view.
Clinical example, patient 2. A, Preoperative frontal view. B, Preoperative base view. C, Postoperative frontal view. D, Postoperative base view.
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