Does an L- strut of 1.5cm need to remain in the septum for nasal bridge and tip support?

Question

Hello I keep reading in peer reviewed medical journals About the L strut in septoplasty in terms of support mechanisms. Can any surgeons shed insight on this topic? I have a deviated caudal septum and I am trying to learn as much as I can. Any information is appreciated thank you

Christian Conderman, MD · Answer

Hi! 
Great Question. In nasal surgery, the septum does have an important role in supporting the nasal tip and the L-strut is the portion of the cartilaginous septum that is left after the septal deviations have been addressed and/or the septal cartilage has been removed for grafting purposes. In general, the minimum recommended width of residual dorsal or caudal L-strut is 10-15 mm depending on the inherent strength of the cartilage. In some cases, we have to augment the caudal portion of the L-strut to strengthen the tip support and straighten a caudal septal deviation (caudal septal extension or caudal septal replacement graft). Hope that helps!

Jeffrey Lisiecki, MD · Answer

First off, it is not necessary always to harvest septum and create an L-strut to perform a septoplasty and get the septum straight to improve breathing and straighten the nose.  Depending on the shape of the septum and where the deviation is, it can help though.  Creating an L-strut and harvesting the rest of the septal cartilage is also very helpful when performing a rhinoplasty because the cartilage is then used for grafts to change the shape of the nose.  1.5cm is a good, conservative L-strut that will typically be more than strong enough, and I do leave 1.5cm behind when I can, but the minimum is generally 1cm for individuals with strong cartilage.

Does an L- strut of 1.5cm need to remain in the septum for nasal bridge and tip support?

Answers (2)

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