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1 online ML Comm Case Report Korean J Otorhinolaryngol-Head Neck Surg 2015;58(11):793-7 / pissn / eissn Caudal Septal Extension Graft Using Nasal Septal Osteocartilaginous Graft Eun Sub Lee, Yong Kyung Kang, Sang Won Yoon, and Ji Sun Kim Department of Otolaryngology-Head and Neck Surgery, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea 비중격골 - 연골이식물을이용한미단부비중격연장이식술 이은섭 강용경 윤상원 김지선 을지대학교의과대학을지병원이비인후과학교실 Received May 12, 2015 Revised June 17, 2015 ccepted June 23, 2015 ddress for correspondence Ji Sun Kim, MD, PhD Department of Otolaryngology-Head and Neck Surgery, Eulji Medical Center, Eulji University School of Medicine, 68 Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Korea Tel Fax vicky96@eulji.ac.kr The septal extension graft from the septum has become a common method of correcting a small or drooping nose in Korea. It can provide superior tip projection and definition if there is a sufficient amount of cartilage and nasal septal stability. In our case, the caudal type septal extension graft was applied unilaterally using septal osteocartilaginous graft harvested in one piece during septoplasty. It was useful in patients who needed septal extension graft in spite of the insufficient amount of available septal cartilage. For those patients, it could be used to achieve the cephalic rotation of drooping tip and the strengthening of septal support effectively. The nasal septal osteocartilaginous graft may serve as an alternative material for conchal cartilage or costal cartilage for caudal septal extension graft if the stable nasal support is maintained and the harvested graft is applied appropriately. Korean J Otorhinolaryngol-Head Neck Surg 2015;58(11):793-7 Key WordsZZNasal cartilage ㆍ Nasal septum ㆍ Rhinoplasty ㆍ Septal extension graft. 서론 증례 증례 1 Copyright 2015 Korean Society of Otorhinolaryngology-Head and Neck Surgery 793

Korean J Otorhinolaryngol-Head Neck Surg 2015;58(11):793-7 C Fig. 1.

The bilateral mucoperichondrial flap of the septum was raised ().

The excess portions of the caudal strut were overlapped and sutured (C).

Techniques involving use of cartilage-bony septum for septal extension

The harvested cartilage-bony septum with several holes bored through it

2 Korean J Otorhinolaryngol-Head Neck Surg 2015;58(11):793-7 C Fig. 1. Cutting and suture technique for the correction of caudal septal deviation. The bilateral mucoperichondrial flap of the septum was raised (). The caudal strut was cut using scissors at the convex-most region (). The excess portions of the caudal strut were overlapped and sutured (C). Fig. 2. Techniques involving use of cartilage-bony septum for septal extension graft. The harvested cartilage-bony septum with several holes bored through it using eighteen-gauge needle or drill. Cartilage-bony septum fashioned for caudal septal extension graft (). The graft was fixed at one side to caudal part of the L-strut using quilting mattress sutures with 5-0 PDS (). PDS: polydioxanone. 증례 2 794

3 Septal Extension Graft Using Septal Osteocartilaginous Lee ES, et al. C D E C D E F G H I J F G H I J Fig /M. Previous view of patient who had undergone rhinoplasty. Patient had deviated nose with mild hump and drooping tip (, C, E, and G). t 12 months postoperatively, there was a significant improvement in deviated nose and drooping tip (, D, F, and H). ony work: both lateral/medial osteotomy with percutaneous root osteotomy and hump removal with rasping. Cartilage work: cut and suture techinique for correction of caudal septum/ caudal septal extension graft by nasal osteocartilagenous graft/ onlay graft Dorsal augmentation with homologous fascia lata (I and J). Fig /F. Previous view of patient who had undergone rhinoplasty. Patient had mild deviated nose with very thick skin and drooping tip (, C, E, and G). t 6 months postoperatively, there was a significant improvement in deviated nose and drooping tip (, D, F, and H). ony work: both lateral/medial osteotomy. Cartilage work: figure of 8 suture for correction of caudal septum/caudal septal extension graft by nasal osteocartilagenous graft/shield graft Dorsal augmentation with homologous fascia lata and crushed septal cartilage Partial resection of depressor septi nasi muscle (I and J)

4 Korean J Otorhinolaryngol-Head Neck Surg 2015;58(11):793-7 고찰 REFERENCES 1) yrd HS, ndochick S, Copit S, Walton KG. Septal extension grafts: a method of controlling tip projection shape. Plast Reconstr Surg 1997; 100(4): ) Ha RY, yrd HS. Septal extension grafts revisited: 6-year experience 796

5 Septal Extension Graft Using Septal Osteocartilaginous Lee ES, et al. in controlling nasal tip projection and shape. Plast Reconstr Surg 2003; 112(7): ) Jeong JY. Obtaining maximal stability with a septal extension technique in East asian rhinoplasty. rch Plast Surg 2014;41(1): ) Choi JY, Kang IG, Javidnia H, Sykes JM. Complications of septal extension grafts in sian patients. JM Facial Plast Surg 2014;16(3): ) Dhong ES. Septorhinoplasty: Endoscopic pproach and Reinforcement of Nasal Support Line. J Korean Soc esthetic Plast Surg 2010;16 (3): ) Jang YJ, Yeo NK, Wang JH. Cutting and suture technique of the caudal septal cartilage for the management of caudal septal deviation. rch Otolaryngol Head Neck Surg 2009;135(12): ) Park CH, Lee SO, Hong SJ. Use of Septal Extension Grafts in Nasal Tip Plasty. Korean J Otolaryngol-Head Neck Surg 2005;48(10): ) Kang JG, Ryu J. Nasal tip surgery using a modified septal extension graft by means of extended marginal incision. Plast Reconstr Surg 2009;123(1): ) Toriumi DM. New concepts in nasal tip contouring. rch Facial Plast Surg 2006;8(3): ) Toriumi DM. Structural approach to primary rhinoplasty. esthet Surg J 2002;22(1): ) Miles, Petrisor D, Kao H, Finn R, Throckmorton GS. natomical variation of the nasal septum: analysis of 57 cadaver specimens. Otolaryngol Head Neck Surg 2007;136(3): ) Kim JS, Khan N, Song HM, Jang YJ. Intraoperative measurements of harvestable septal cartilage in rhinoplasty. nn Plast Surg 2010;65 (6): ) Jang YJ, Kim JM, Yeo NK, Yoo JH. Use of nasal septal bone to straighten deviated septal cartilage in correction of deviated nose. nn Otol Rhinol Laryngol 2009;118(7): ) Choi SH, Lee HG, Kim DH, Kim SW, Cho JH, Park YJ. ony batten graft for correction of caudal septal deviation. Korean J Otorhinolaryngol-Head Neck Surg 2008;51(10):

online ML Comm Clinical Review Korean J Otorhinolaryngol-Head Neck Surg 2013;56: / pissn / eissn

online ML Comm Clinical Review Korean J Otorhinolaryngol-Head Neck Surg 2013;56:684-91 / pissn 2092-5859 / eissn 2092-6529 http://dx.doi.org/10.3342/kjorl-hns.2013.56.11.684 Tailored Correction of Deviated