Essentials of Septorhinoplasty 2nd Edition: Philosophy, Approaches, Techniques PDF
|Author||Hans Behrbohm and Eugene Tardy|
|File size||54.33 MB|
|Category||Free Medical Books|
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Young sailors in the International Optimist class trim their sails with the help of a tensioning pole called a sprit. The stronger the wind, the more tightly the sprit is set. The lower the tension on the sprit, the more the sail will billow open. This change in the shape of the sail is clearly reflected in the adjacent top triangles. A similar mechanism is at work in the nose. The height and tension of the anterior septum significantly affect the aperture angle of the nasal valve and the tension and shape of the tip and supratip area. The goal of any structure-conserving surgery of the nose, as in the spritsail, is to change the shape of the internal and external nose by altering the tension and traction on specific structural elements (Fig. 1.1). The nose performs a variety of functions. It is a respiratory and sensory organ and has a special aesthetic importance as a central feature of the face. It is a reflex organ and adds resonance to phonation. The functional and aesthetic aspects of the nose are inseparably linked in a morphological sense.1 It is our experience that functional and aesthetic problems of the nose almost always coincide. Rhinosurgery aimed exclusively at improving function will very quickly reach its limits if it disregards external form.
This is clearly illustrated by the “tension nose,” deviated nose, and saddle nose. Conversely, rhinosurgery that is done purely for aesthetic goals forfeits valuable opportunities, as in the cases where the impact of septal surgery on nasal tip aesthetics is not used to modify tip definition, projection, and rotation.2,3 Goldman found that in more than 70% of his cases, the presence of septal deviation coexisted with a deformity of the external nose.4 Meyer performed a concomitant septoplasty in 80% of his primary and secondary rhinoplasties.5 Masing explained the importance of external nasal shape in