Department of Otorhinolaryngology Head and Neck Surgery

Faculty of Medicine - Andalas University

Dr. M. Djamil Hospital, Padang 2014

Septorhinoplasty Technique

Chandra - Nur
Facial Plastic and Reconstructive Surgery SubDivision
 Definition

Rhinoplasty  General name for any surgical

procedure that modifies the shape or restores
the tissues of the nose for the purpose of
improving function , appearance, or both.
Septoplasty is the name given to any surgical
correction done to the nasal septum
Both  Septo-Rhinoplasty
Berghaus A. Rhinoplasty, aesthetic-plastic surgery of the nose. Halle-Wittenberg:Martin-
Facial Plastic & Reconstruction Surgery SubDivision
Luther-University
 ANATOMY

Berghaus A.Plastic
Facial Rhinoplasty, aesthetic-plastic
& Reconstruction surgery of the
Surgery SubDivision
nose. Halle-Wittenberg:Martin-Luther-University
 ANATOMY

 Surgical Anatomy of the Nose, Bailey Head and Neck Otolaryngology

Facial Plastic & Reconstruction Surgery SubDivision
Nolsttrenite GJ. Rhinoplasty. A practical guide to functional and aesthetic surgery
of the nose. 3rd Facial Plastic & Reconstruction Surgery SubDivision
edition. The Hague: Kugler publication; 2005.
Toriami DM, Becker DG&Rhinoplasty
Facial Plastic Dissection
Reconstruction Surgery Manual, Willam
SubDivision
 Goals of surgery

 Exposure of the pathologic portion of

septum
 Removal or reconstruction of the defective
portions
 Preserve nasal mucosa and lining
 Prevent external deformity of patient

Aiach G. Open rhinoplasty and cartilage grafting. Paris

Facial Plastic & Reconstruction Surgery SubDivision
Photo documentation and perform a detailed
anatomical analysis

• Overall look of the frontal face

• Whole face look from the right and left lateral
• Obliq whole face looks right and left
• Basal nasal tip rice extension so that the patient
lies parallel to the eyebrows.

Nolsttrenite Facial
GJ. Rhinoplasty. A practical Surgery
Plastic & Reconstruction guide to functional and aesthetic surgery
SubDivision
rd
of the nose. 3 edition. The Hague: Kugler publication; 2005.
 Documentation

Nolsttrenite Facial
GJ. Rhinoplasty. A practical Surgery
Plastic & Reconstruction guide to functional and aesthetic surgery
SubDivision
of the nose. 3rd edition. The Hague: Kugler publication; 2005.
 Incisions type

A. Insisi caudal septal (hemitransfiksi)

2mm incision starting from the caudal limit of the
septum. These incisions result in access to the septum,
the premaxilla and anterior nasal spine, dorsum nasi,
columella, and the base of the pouch of rice.

Nolsttrenite GJ. Rhinoplasty. A practical guide to functional and aesthetic surgery

Facial Plastic & Reconstruction
rd Surgery SubDivision
of the nose. 3 edition. The Hague: Kugler publication; 2005.
Nolsttrenite GJ. Rhinoplasty. A practical guide to functional and aesthetic surgery
ofFacial Plastic &rdReconstruction Surgery SubDivision
the nose. 3 edition. The Hague: Kugler publication; 2005.
B. Incision interkartilagenous
Skin incision is made in the cranial to caudal
vestibular of cartilage. These incisions result in
access to the dorsum of rice and vault bone and
cartilage, valve area, and lobul.

Nolsttrenite GJ. Rhinoplasty. A practical guide to functional and aesthetic surgery

ofFacial Plastic3&rdReconstruction
the nose. edition. The Hague:
Surgery Kugler publication; 2005.
SubDivision
Nolsttrenite GJ. Rhinoplasty. A practical guide to functional and aesthetic surgery
ofFacial Plastic &rdReconstruction Surgery SubDivision
the nose. 3 edition. The Hague: Kugler publication; 2005.
C. Vestibulum incision
The incision curves form a low position on the right
vestibulum skin on the lateral border of the piriformis
aperture. These incisions result in access to the paranasal
area, aperture piriformis, lateral wall cavity rice.

Nolsttrenite GJ. Rhinoplasty. A practical guide to functional and aesthetic surgery

of
Facial nose. &3rdReconstruction
the Plastic edition. The Surgery
Hague:SubDivision
Kugler publication; 2005.
Nolsttrenite GJ. Rhinoplasty. A practical guide to functional and aesthetic surgery
ofFacial Plastic &rdReconstruction Surgery SubDivision
the nose. 3 edition. The Hague: Kugler publication; 2005.
D. Incision infrakartilagenous
An incision at the caudal limit of the crucible lateral,
dome, and medial crucible of the lobular cartilage, can
also be called a marginal incision. This results in the
access incision and dome kartilagenous lobular cartilage

Nolsttrenite GJ. Rhinoplasty. A practical guide to functional and aesthetic surgery

ofFacial Plastic3&rdReconstruction
the nose. edition. The Hague:
Surgery Kugler publication; 2005.
SubDivision
Nolsttrenite GJ. Rhinoplasty. A practical guide to functional and aesthetic surgery
ofFacial Plastic &rdReconstruction Surgery SubDivision
the nose. 3 edition. The Hague: Kugler publication; 2005.
E. inverted V incision
Trancolumellar Incision is horizontal inverted V shape on
the columella, an incision is made in the third basal and
combined with infrakartilaginous incision on both sides.
This incision produces a broad and direct access to the
lobular cartilage, cartilage dorsum of rice, and the anterior
septum.

Nolsttrenite GJ. Rhinoplasty. A practical guide to functional and aesthetic surgery

Facial Plastic & rd
of the nose. 3 Reconstruction
edition. The Surgery
Hague:SubDivision
Kugler publication; 2005.
Nolsttrenite GJ. Rhinoplasty. A practical guide to functional and aesthetic surgery
Facial Plastic & rd
of the nose. 3 Reconstruction
edition. The Surgery
Hague:SubDivision
Kugler publication; 2005.
 Technique operation

Hemitransfixion incision Dissection the caudal of septum

Widiarni D, Panduan teknik diseksi septorinoplasti

Columella pocket Septal canal

Widiarni D, Panduan teknik diseksi septorinoplasti

Inferior septal canal Mobilization swinging door

Widiarni D, Panduan teknik diseksi septorinoplasti

Septal
dissection

Widiarni D, Panduan teknik diseksi septorinoplasti

 Post Operatives
Packing  goal of the nose
packing:
to ensure good tissue
approximation
to prevent hematomas,
swelling and bleeding
to prevent synechia
to prevent displacement
splinting
Nolst Trenite G.J, Aesthetics, Rhinoplasty, A practical guide to
functional and aesthetic surgery of the nose
 Post Operatives
• The goal is(external nose
dressing), :
• to fix the skin on the under-
layer, thereby reducing dead
space
• to prevent hematomas and
swelling
• to prevent displacement by
outside trauma
• to prevent widening of the
lateral walls by intranasal
edema
Nolst Trenite G.J, Aesthetics, Rhinoplasty, A practical guide to functional
and aesthetic surgery of the nose
 Complications
• Early : • Late :
1. Extensive edema and 1. Nose passage disorders
ecchymosis 2. Septal perforation
2. Allergic skin reactions 3. Deviation and irregularities
to cloth-tape of the dorsum
3. Hematomas 4. Paranasal callus
4. Infections 5. Saddle nose
5. Skin ischemia and 6. Tip distortion
necrosis
7. Tip ptosis
8. Columella retraction

Nolsttrenite GJ. Rhinoplasty. A practical guide to functional and aesthetic surgery

of the nose. 3rd edition. The Hague: Kugler publication; 2005.
•Thank You

Facial Plastic & Reconstruction Surgery SubDivision