Endonasal placement of spreader grafts in rhinoplasty.
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Described for the first time in the 1930s by Rethi, the external approach would not have survived without its obvious advantages. It is practiced exclusively by certain authors giving the belief of better, more reliable or more durable results. This is in contrast to those who use this technique only for particular indications. This controversy emphases the need of evaluating the theoretical advantages and disadvantages of this approach relying on research. Indeed, it is clear to everybody that whatever the approach, the results initially depend more on the clinical analysis then on the qualification of the surgeon. So, if this controversy has no reason to be, moderate indications are probably useful to be set for the guidance of young rhinoplasticians.
It is quite easy to significantly modify the nasal bone. In most cases, the dorsonasal skin, which is often thin and elastic, will adapt to the new osteocartilaginous frame. On the contrary, the thickness is different at the tip of the nose, where the skin is often thicker than at the dorsonasal level. Surgery should preferably be performed first on the tip of the nose, whose new shape will allow adjusting the new structure of the nasal bone.
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From 1981 to 1986, a total of 11 cases of crooked nose were treated. The method include resection of the excessive portion of deviated lateral cartilage, and reduction of significantly dislocated lower part of septum, otherwise correction could not be radical.