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Case Reports in Surgery and Invasive Procedures | Volume 3
March 11-12, 2019 | London, UK
Biomarkers
Plastic and Cosmetic Surgery
International Conference on
International Conference on
Joint Event
&
Rhinoplasty: Spare roof technique - A new approach to the dorsum
Miguel Gonçalves Ferreira
Hospital Santo Antônio, Portugal
S
ince 2014 we have been developing the Spare Roof
Technique - SRT. According to many authors, in rhinoplasty,
the most difficult segment of control is the dorsum. Most
revisions are due to latrogenic manouvers on the dorsum and
unpredictability in its healing / special reorganization in the so-
called K area. The transition from the upper 1/3 to the middle
1/3 is clearly a critical area in the stability of the nasal pyramid -
area of bone-cartilaginous transition. In this region, the superior
alveolar cartilage extends cephalically up to 10 mm underneath
the bones of the nose. In the Caucasian nose the most relevant
dysmorphic feature is theHump, inbothgenders. The treatment
of this dysmorphia has been reported since the times of ancient
Egypt. In the 1980s and 1990s more advanced techniques were
popularized and much research work was done. Today there
are clearly two types of techniques from the conceptual point
of view - the “surface” and those that work the most basal part
of the nasal pyramid - the “structurants”. The techniques most
practiced and teached in the western world are clearly the
surface ones: “Humpectomy en bloc” - HEB and “Split Hump
Technique” - SHT are the techniques that dominate this group
and are most used in all reduction rhinoplasty. In HEB the block
is removed, i.e. the whole osteo-cartilaginous set is removed
en bloc - thereby destroying the K area and the Upper Lateral
Cartilage - ULCs. In this technique it is mandatory to reconstruct
this area, mainly with spacer grafts - Spreader Grafts.
In SHT the ULCs are only separated in the midline, and they
are used to confine the Spreader Flaps - this is a less aggressive
technique for the stability of the middle 1/3. SHT is clearly the
most commonly used technique today. Minor variations of this
technique have been described which, while important, do not
fully meet the needs felt on a day-to-day basis.
The persistent difficulty in achieving harmonious and soft
dorsuns has led to the development of numerous camouflage
techniques - namely for intermediate and fine skins. From
the temporal fascia to cartilage powder (ex-diced), passing
through the interposition of fat, muscle or other materials.
These techniques are not always fully effective and the long-
term results remain clearly unsatisfactory in the subgroup
candidate for revision surgery. In this context, the idea arises
of preserving important structures like the ULCs and the Spare
Roof Technique - SRT is developed. Conceptually this technique
has the following 4 steps:
1. Separation of the upper part of the quadrangular septum
from the ULCs
2. Exérisis of the excess cartilage along the upper edge of the
septum
3. Ostectomy of the caudal portion the Nasal Bones - NB -
preserving the ULCs immediately by low-step performed
with ultrasonic surgery or diamond drill.
4. Suture of the ULCs to the remaining quadrangular septum
in order to avoid the spring/convex effect of the ULCs.
In this way, we achieve a uniformly smooth and structurally
stable dorsum (demonstrated by our outcomes and by
engineering calculations). From the structural point of view
there is an alteration of the area K which is moved cephalically
between 3 and 10 mm.
e:
mgferreira.md@gmail.com