Abstract
Shaping a proper dorsum must constitute an essential part of rhinoplasty. This article addresses the main current concepts that play a significant role in dorsal modifications: proper exposure at the keystone, component separation and incremental reduction, straightening the septum and positioning it in the midline, mobilizing and reshaping the nasal bones by osteotomies and osteoplasties, and finally reconstituting a barrel vault of appropriate width and proper contour. The importance of power tools and piezoelectric instrumentation is highlighted, as well as the relevance of simulation and computed tomography (CT) imaging as key to bone and septal work. Finally, the key principles of rebuilding the dorsum in revision rhinoplasty are detailed.
Zusammenfassung
Als ein maßgeblicher Bestandteil der Rhinoplastik ist die Formung eines ästhetisch ansprechenden Nasenrückens anzusehen. Der vorliegende Beitrag geht auf die wesentlichen aktuellen Konzepte ein, die von erheblicher Bedeutung für Modifikationen des Nasenrückens sind: die exakte Darstellung des Rhinions („keystone area“), d. h. des Knochen-Knorpel-Übergangs am Nasenrücken, die Separation der Komponenten und schrittweise erfolgende Verkleinerung, die Begradigung des Septums und seine Positionierung in der Mittellinie, die Mobilisierung und Neuformung der Nasenbeine mittels Osteotomien und Osteoplastiken und schließlich die Wiederherstellung eines Gewölbes geeigneter Weite und passender Kontur. Dabei wird sowohl die Wichtigkeit von elektrischen und piezoelektrischen Instrumenten herausgestellt als auch die Relevanz der Simulation und der computertomographischen Bildgebung als Schlüssel zur Bearbeitung von Knochen und Septum. Abschließend werden die wesentlichen Grundsätze beim Wiederaufbau des Nasenrückens im Rahmen einer Revisionsrhinoplastik eingehend beschrieben.
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E. Robotti declares that he has no competing interests.
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Robotti, E. Shaping the nasal dorsum. HNO 66, 92–102 (2018). https://doi.org/10.1007/s00106-017-0425-x
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DOI: https://doi.org/10.1007/s00106-017-0425-x