03 larrabee revision rhinoplasty - ucsfcme.com

1

Revision Rhinoplasty

Wayne F. Larrabee, Jr., M.D.

Clinical Professor

University of Washington

Seattle, Washington

Unilateral Spreader Graft

2

3

Deviated Nose- Unilateral Spreader Graft

Copyright restrictions may apply.

Andre, R. F. et al. Arch Facial Plast Surg 2004;6:36-40.

Spreader grafts

4

Copyright restrictions may apply.

Schlosser, R. J. et al. Arch Facial Plast Surg 1999;1:105-110.

Schematic showing combined use of spreader grafts and flaring sutures to improve the cross-sectional area of the internal valve (from Park11)

Copyright restrictions may apply.

Schlosser, R. J. et al. Arch Facial Plast Surg 1999;1:105-110.

Placement of spreader grafts

5

Non Anatomic Alar GraftOnlay Spreader Graft

from Auricular Concha

6

7

Right Onlay Spreader Graft, Alar Graft, Strut, Shield Tip Graft from

Auricular Cartilage

8

Non Anatomic Lateral Crural Graft

Auricular Cartilage

9

10

Alar Batten Grafts

11

12

Right Spreader Graft, Right Alar Batten Graft, Columellar Strut

Alar Composite Graft

13

Alar Retraction

14

Composite Graft

15

16

Composite Graft, Shield Graft

17

Extended Columellar Tip Graft

Copyright restrictions may apply.

Pastorek, N. J. et al. Arch Facial Plast Surg 2005;7:176-184.

Preoperative (A and C), 6-month postoperative (B and D), and intraoperative (E-L) views in the case of a 45-year-old woman who presented with a history of a rhinoplasty by another surgeon

18

19

20

Tongue in Groove

Copyright restrictions may apply.

Kridel, R. W. H. et al. Arch Facial Plast Surg 1999;1:246-256.

The transfixion incision and retrograde dissection between the medial crura

21

Copyright restrictions may apply.

Kridel, R. W. H. et al. Arch Facial Plast Surg 1999;1:246-256.

After the creation of the medial crural pocket, the medial crura are advanced onto the denuded caudal septum

Copyright restrictions may apply.

Kridel, R. W. H. et al. Arch Facial Plast Surg 1999;1:246-256.

Once the precise desired relationship between the medial crura and the septum is obtained, suture fixation is carried out

22

Copyright restrictions may apply.

Kridel, R. W. H. et al. Arch Facial Plast Surg 1999;1:246-256.

The excess membranous septum is trimmed bilaterally after advancing the membrane anteriorly

Copyright restrictions may apply.

Kridel, R. W. H. et al. Arch Facial Plast Surg 1999;1:246-256.

The transfixion incision is closed with interrupted absorbable suture

23

Copyright restrictions may apply.

Kridel, R. W. H. et al. Arch Facial Plast Surg 1999;1:246-256.

A, To correct a hanging columella, the medial crura are evenly advanced cephalically onto the denuded septal cartilage

Revision Rhinoplasty• Caudal septal extension

graft

• Extended spreader grafts

• Lateral crural replacement grafts (auricle)

• Columellar strut

• Cap graft (bruised septal cartilage)

• Temporalis fascia graft

• Osteotomies

24

25

26

27

28

29

30

31

32

Ravaged Tip

• Auricular Cartilage Grafts

• Spreader Grafts

• Alar Batten Grafts

• Shield Grafts

33

34

Auricular Cartilage Grafts-Spreaders, Alar Batten, Shield

35

Internal to External Osteotomy

36

The Crooked Nose

• Septum

• Spreader Grafts

• Sequential Osteotomies

• Intermediate Osteotomies

• Camouflage

• Camouflage

• Camofluage.

“Like Opening a Book”

37

38

39

40

41

The End