Role of the Septum in Surgery of the Nasal Contour

Abstract

To the rhinologist practicing surgical correction of the nasal contour the nasal septum no longer is only the nasal partition but is the foundation of the nasal pyramid. It consists of the following structures: the perpendicular plate of the ethmoid, the vomer, the septal cartilage with its wings (the upper lateral cartilages), the medial divisions of the lower lateral cartilages, the anterior nasal spine, the septal membrane, the crest of the maxilla and of the palate bone and the nasal spur of the frontal bone.In this study the head in the erect position is to be considered, so that the various borders mentioned may be clearly visualized.The perpendicular plate of the ethmoid is a thin, flat bone that fits into the upper part of the sutures between the nasal bones but mainly descends from the cribriform plate and rarely takes any part in the formation of an abnormal nasal contour. Its injuries or deviations have no effect on the nasal contour.The vomer mainly supports the septal cartilage, but its own irregularities do not cause any nasal disfigurement unless a trauma to it causes expulsion of the septal cartilage from the vomerian groove.The nasal septal cartilage is the most important constitutent of the septum from the standpoint of contour and must be taken up in detail.The septal cartilage consists of two parts: first a straight, flat portion (that part which fills in the irregular space between the vomer and the perpendicular plate and the intranasal sutures); second, its wings, which project on each side from its anterior border, better known as the upper lateral cartilages. Embryologically these structures (the septal cartilage and its wings) are one. Therefore, nature intended them to be one. The septal cartilage is kept in the central place not only by its junction with the perpendicular plate and vomer but by these guy ropes (wings) which are attached to the bony margins of the piriform aperture. The wings put together are almost From the

Use of umbrella graft for nasal tip projection

“…The clinical application of septal grafts were first proposed by Cohen [2] and Metzenbaum [6]. Foman et al [4] used a button graft carved from septal cartilage for nasal tip projection.…”