0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Surgical Technique |

Oblique Septal Crossbar Graft for Anterior Septal Angle Reconstruction

Zeeshan S. Aziz, MD; Michael J. Brenner, MD; Harrison C. Putman III, MD
Arch Facial Plast Surg. 2010;12(6):422-426. doi:10.1001/archfacial.2010.92.
Text Size: A A A
Published online

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.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Figures

Place holder to copy figure label and caption
Figure 1.

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.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

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).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.

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.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.

Variations on placement of oblique septal crossbar graft. A, Lateral view. B, Oblique view.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 5.

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.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 6.

Clinical example, patient 1. A, Preoperative frontal view. B, Preoperative base view. C, Postoperative frontal view. D, Postoperative base view.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 7.

Clinical example, patient 2. A, Preoperative frontal view. B, Preoperative base view. C, Postoperative frontal view. D, Postoperative base view.

Graphic Jump Location

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 2

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles
Jobs
brightcove.createExperiences();