septoplasty is an important part of nasal surgery. aproach for caudal dislocations will be discussed

Septal extension grafts (SEGs) are structural grafts placed along the septal cartilage to stabilize and define nasal tip projection, rotation, and shape. Originally described by Toriumi nearly three decades ago as a caudal septal extension graft primarily for correcting columellar retraction, the technique was later modified by Byrd et al. to address nasal tip control, offering three distinct graft variations. Byrd’s version introduced superior projection at a 45° angle, which unfortunately positioned the graft’s axis vertically against the forces acting on the nasal tip, unlike Toriumi’s more force-aligned concept.

In endonasal rhinoplasty, Margulis and Harel (2007) introduced the “horizontal columellar strut,” a conceptually similar SEG applied through a closed approach. However, both external and endonasal SEG techniques continued to evolve. In my practice, I found that repositioning the graft from a horizontal (cephalocaudal) to a vertical (inferosuperior) orientation increased its mechanical stability and simplified fixation to the caudal septum.

SEGs provide superior control of nasal tip dynamics compared to traditional columellar struts, which lack firm anchorage to the septum and thus offer limited long-term support. However, drawbacks such as reduced nasal tip flexibility and potential asymmetry from unilateral grafting exist. These limitations can be mitigated through bilateral grafting or by thinning the distal portion of the graft to preserve elasticity.

My surgical approach avoids a one-size-fits-all philosophy. I adapt my technique intraoperatively based on septal shape and asymmetry. For instance, in cases of caudal septal concavity, I carve a graft to match the curve. If symmetry is still an issue, bilateral grafts are employed. Rather than relying on excessive tension from medial crura to increase projection, I often use cap grafts or ANSA banner-type SEGs (as per Perez et al.) to achieve a natural yet stable nasal tip.

Description

This video presentation focuses on the importance of dorsum and sidewall aesthetics in rhinoplasty, with special emphasis on modern osteoplasty techniques using a burr machine. While nasal tip refinement often dominates rhinoplasty discussions, achieving smooth dorsal lines and well-contoured sidewalls is equally critical for natural results. I will outline my approach to dorsal preservation and precise sidewall shaping, highlighting the role of powered burr-assisted osteoplasty in minimizing irregularities and optimizing surgical control.

Outcome Objectives

By the end of this session, participants will:

1. Understand the key aesthetic principles of the nasal dorsum and sidewalls.
2. Learn the advantages of burr-assisted osteoplasty in creating smooth and symmetrical nasal contours.
3. Apply safe and effective osteoplasty techniques in both primary and revision rhinoplasty to enhance dorsum and sidewall aesthetics.

Background

Dorsal and sidewall management is fundamental to successful rhinoplasty. Traditional osteotomy techniques may carry risks of step-offs and irregularities, particularly in complex cases. The use of powered burr systems allows for controlled bone sculpting, providing smoother transitions and improved contour precision. This presentation will explore the integration of burr-assisted osteoplasty into rhinoplasty practice, supported by clinical examples and surgical tips.

VIDEOS OF PRESERVATION RHINOPLASTY WILL BE SHARED DURİNG THIS SESSİON

Orbital and optic nerve decompression: When and how?

speech about Diagnosis and management of nasal septal perforation

Functional problems and correction of these problems are one of the main reasons for patients seeking corrective surgery. This panel especially addresses these issues and speakers will present their solutions to functional problems