Summary
Background
In the rhinoplasty of Asian short nose deformity, the surgeon cuts a portion of septal
cartilage and retains the nasal septum L-strut, but a deviated nasal septum is formed
after the surgery under forces of soft tissue contracture. Although various autologous
grafts are used to reinforce the L-strut, there is a lack of objective “mechanical
theory” to support the clinical findings in other studies at the present time.
Methods
A simplified and geometrical finite element model of L-strut reinforced with clinically
common materials, including auricular cartilage, nasal septal cartilage, and perpendicular
plate of ethmoid, was established. Simulating the mechanical environment of nasal
tip in reality, when the force was loaded, the von Mises stress and directional deformation
of the L-strut were observed under different widths. Kruskal–Wallis test was used
to examine the significance of intergroup differences of L-strut, and P < 0.05 indicated statistical significance.
Results
All autologous grafts decreased the maximum directional deformation of L-strut, and
the variance of nasal tip displacement was reduced; the perpendicular plate of ethmoid
showed a distinct effect. The increasing width of the L-strut reduced the maximum
displacement of the nasal tip, but the influence of using grafts as a reinforcement
to the L-strut was much greater than the residual width (p = 0.003).
Conclusion
The graft reinforcement significantly increased the stability of the L-strut, which
enhanced the resistance to deformation in the long-term action of tension, and the
effect of the perpendicular plate of ethmoid to reinforce was significantly better
than that of auricular and nasal septal cartilage.
Keywords
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Article info
Publication history
Published online: August 23, 2022
Accepted:
August 17,
2022
Received:
January 10,
2022
Identification
Copyright
© 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
