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.