Surgical Technique.
The T-graft is moved in cephalic- caudal direction alongside the caudal margin of the nasal septum in order to determine the optimal balance of the nose regarding nasal length and nasal tip projection (Figure 2 a-c). Once the desired position is determined the graft can be suture fixated to the nasal septum. This can be performed with (non-) soluble sutures like Nylon or PDS 4/0. Preferably this is performed with 3 sutures in order to prevent cantilever and to provide sufficient stability. After fixation, the T-graft can be tailored with a blade to the match the exact required final dimensions. The T-graft can have two functions depending on the final position in relation to the nasal septum. These functions are splinting- / septal batten graft, or septal extension graft.
Splinting- / septal batten graft .
When the T-graft is placed at the level of the caudal margin of the nasal septum it acts like a splinting- or septal batten graft. When the caudal margin of the nasal septum is deviated the T-graft is placed on the concave or non-deviated side. This can be combined with scoring of septal cartilage on the concave side of the deviation in order to weaken the cartilage before the T-graft is suture fixated. In this fashion the T-graft and straightens and stabilizes the deviated nasal septum. In similar fashion the T-graft can act like a septal batten graft to improve tip support when the nasal septum is too floppy. Indications for this position are tick skinned patients, a floppy cartilaginous nasal framework or under projection or -rotation of the nasal tip.