The use of titanium clips in septal surgery for correction and strengthening

Published:January 03, 2012DOI:


      Permanent correction of septal deformities is one of the most difficult and controversial subjects in aesthetic nasal surgery. The main reasons for failure in most of the corrective procedures are either not to weaken the septal cartilage enough to straighten it, or to treat the septum too radically causing iatrogenic deformities or predisposing it to new deformities postoperatively.
      Our approach to correct septal deformities relies on the principle of strengthening/reinforcing the septal cartilage (with or without some weakening maneuvers to correct the deformities beforehand) with application of titanium hemoclips at some critical locations in septum.
      Eighty-seven patients operated on between 2007 and 2009 are included in this study. Thirty-six of these patients had combined septo-nasal deformities while the remaining 51 had solely septal deformities. In 30 patients with septo-nasal deformity the technique was proven to be successful. The remaining 6 patients of this group had axial nasal deformity (rather than intrinsic septal problems) and did not respond to our technique successfully.
      Within four years of follow up, we did not encounter any recurrences, infections, ulcerations or exposure in the mucosa covering the titanium clips. None of the titanium clips were required to be removed for any reasons.


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        • Ramirez O.M.
        • Pozner J.N.
        The severely twisted nose. Treatment by separation of its components and internal cartilage splinting.
        Clin Plast Surg. 1996; 23: 327-340
        • Converse J.M.
        Corrective surgery of nasal deviations.
        Arch Otolaryngol. 1950; 52: 671-708
        • Johnson C.M.
        • Anders J.R.
        The deviated nose: it’s correction.
        Laryngoscope. 1977; 87: 1680-1684
        • Rees T.D.
        Surgical correction of the severely deviated nose by extramucosal excision of the osseocartilaginous septum and replacement as a free graft.
        Plast Reconstr Surg. 1986; 78: 320-330
        • Rees T.D.
        Correction of the deviated nose.
        in: Rees T.D. LaTrenta G.S. Aesthetic plastic surgery. 2nd ed. WB Saunders, Philadelphia1994: 293-334
        • Dingman R.O.
        Correction of nasal deformities due to defects of the septum.
        Plast Reconstr Surg. 1956; 18: 291-304
        • Gorney M.
        Correction of the deviated nose. An annotated surgical report.
        Clin Plast Surg. 1981; 8: 201-210
        • Rohrich R.J.
        • Gunter J.P.
        • Deuber M.A.
        • Adams Jr., W.P.
        The deviated nose: optimizing results using a simplified classification and algoritmic approach.
        Plast Reconstr Surg. 2002; 110: 1509-1523
        • Guyuron B.
        • Uzzo C.D.
        • Scull H.
        A practical classification of septonasal deviation and an effective guide to septal surgery.
        Plast Reconstr Surg. 1999; 104: 2202-2209
        • Park S.S.
        The deviated nose.
        in: Behrbohm H. Tardy Jr., M.E. Essentials of septorhinoplasty philosophy-approaches-techniques. Georg Thieme Verlag, Stuggart, Germany2004: 162-175
        • Dupont C.
        • Cloutier G.E.
        • Prevost Y.
        Autologous vomer bone graft for permanent correction of the cartilaginous septal deviations.
        Plast Reconstr Surg. 1966; 38: 243-247
        • Byrd H.S.
        • Salomon J.
        • Flood J.
        Correction of the crooked nose.
        Plast Reconstr Surg. 1998; 102: 2148-2157
        • Toriumi D.M.
        • Ries W.R.
        Innovative surgical management of the crooked nose.
        Facial Plast Clin North Am. 1993; 1: 63-78
        • Gürlek A.
        • Ersoz-Ozturk A.
        • Celik M.
        • Firat C.
        • Aslan S.
        • Aydogan H.
        Correction of the crooked nose using custom-made high density porous polyethylene extended spreader grafts.
        Aesthetic Plast Surg. 2006; 30: 141-149
        • Calderón-Cuéllar L.T.
        • Trujillo-Hernández B.
        • Vásquez C.
        • Padilla-Acero J.
        • Cisneros-Preciado H.
        Modified mattress suture technique to correct anterior septal deviation.
        Plast Reconstr Surg. 2004; 114: 1436-1441
        • Foda H.M.T.
        The role of septal surgery in management of the deviated nose.
        Plast Reconstr Surg. 2005; 115: 406-415
        • Atagi T.A.
        • Young V.L.
        Alloplastic materials.
        in: Mathes S.J. Plastic surgery. 2nd ed. W.B. Saunders, , New York2006: 745-768
        • Guo L.
        • Tian W.
        • Feng F.
        • Long J.
        • Li P.
        • Tang W.
        Reconstruction of orbital floor fractures: comparison of individual prefabricated titanium implants and calvarial bone grafts.
        Ann Plast Surg. 2009; 63: 624-631
        • Park H.S.
        • Kim Y.K.
        • Yoon C.H.
        Various applications of titanium mesh screen implant to orbital wall fractures.
        J Craniofac Surg. 2001; 12: 555-560
        • Oneal P.R.
        • Izenberg P.H.
        • Schlesinger J.
        Surgical anatomy of the nose.
        in: Daniel R.K. Rhinoplasty. Little, Brown and Company, Boston1993: 3-37
        • Gunter J.P.
        • Rohrich R.J.
        Management of the deviated nose: importance of septal reconstruction.
        Clin Plast Surg. 1988; 15: 43-55
        • Newman M.H.
        Surgery of the nasal septum.
        Clin Plast Surg. 1996; 23: 271-279
        • Seyhan A.
        • Ozaslan U.
        • Sir E.
        • Ozden S.
        Three-dimensional modelling of nasal septal deviation.
        Ann Plast Surg. 2008; 60: 157-161
        • Hurbis C.G.
        A follow-up study of the monarch adjustable implant for correction of nasal valve dysfunction.
        Arch Facial Plast Surg. 2008; 10: 142-143
        • Guyuron B.
        • Behmand R.A.
        Caudal nasal deviation.
        Plast Reconstr Surg. 2003; 111: 2449-2457