Cadaveric and Engineering Analysis of the Septal L‐Strut

Abstract

Intrinsic elasticity of the septal cartilage, the mucoperichondrial flap, and overlap with the bony vault all contribute to the stability of the L-strut, which is enhanced by preserving a small segment of cartilage at the bony-cartilaginous junction of the dorsal L-strut.

Evidence-Based Medicine

“…A common maxim of septoplasty surgery is the preservation of a minimum of height of the remnant L-strut at 10 to 15 mm in order to preserve tip projection and prevent saddle nose deformity. 25 However, mechanical testing to assess the validity of this statement was lacking until recent years. Mau and colleagues 25 described their investigation using finite element modeling of maximal tensile stress at the bony cartilaginous junction as a function of L-strut design.…”

Nasal Reconstruction Using Tissue Engineered Constructs

“…Although advantageous for follow-up and observing for recurrent malignancy, after many years cancer free, patients can often seek a more permanent alternative (we are currently working on compassionate case where the patient refuses to wear a prosthetic nose). 1,7 Studies have also shown that there are increased infections to the wound site of patients wearing a prosthetic nose in addition to reports of physical, psychological, and social insecurities. 1,7 Allogenic sources of tissue have also been considered, 8,9 and in 2005, the first near-total facial composite transplant was reported.…”

“…1,7 Studies have also shown that there are increased infections to the wound site of patients wearing a prosthetic nose in addition to reports of physical, psychological, and social insecurities. 1,7 Allogenic sources of tissue have also been considered, 8,9 and in 2005, the first near-total facial composite transplant was reported. Maxillary and palatal bone was transplanted, with nasal, malar, periauricular, and periorbital soft tissues also transplanted.…”

“…Studies highlight the role of the nasal septum and the L-Strut region in preventing nasal collapse. 7 Tensile testing studies have demonstrated that the average stiffness of the human nasal cartilage is approximately 0.8 MPa; however, this is prone to variations between a range of 0.03 to 1.5 MPa. 14Y17 Other regions of the nose have been investigated in a study, which used the estimations of a panel of experienced head and neck surgeons to suggest the suitability of various engineered grafts for reconstructing specific regions of the nose based on their mechanical rigidity.…”

Reconstruction of the Nasoseptal L-Strut in Rhinoplasty

“…Preserving perichondrial and periosteal continuity across the junction of the septal dorsal remnant as it transitions to septal bone may serve to increase stability. 5 At the posterior septal angle, the caudal septum must be dissected free from the tough attachments to the nasal spine and maxillary crest. The deviated portion of the L-strut is then incised and removed, leaving a cephalic, dorsal remnant of septum in the midline.…”