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SEPTORHINOPLASTY INCISIONS

Incisions are essential in order to approach, reach modify and correct the nasal structure in septorhinoplasty. The septorhinoplasty incisions have a special importance. The intercartilagenous incisions divide the attachment of lateral crus to the upper lateral cartilage and the transfixion incision divides the attachment of the medial crura to the caudal septum. This results in loss of tip support and its unpleasant effects of dropped tip, pollybeak, hanging columella and wider nostrils. Therefore, compensatory means in order to support the tip (new dome creation, or the modified vertical dome division with columellar and tip grafts) are essential manoeuvres following our rhinoplasty incisions.

The choices of incisions varies according to the clinical situation. We currently use the following incisions:
    - Intercartilagenous incision - 100%
    - Transfixion incision - 95%
    - Marginal incision - 90%
    - Alar wedge incision - 20%
    - Transcolumellar incision - 2%
Types and Indications:
  1. Transfixion incisions:
    1. Modified transfixion incision:
      Carried out around the superior septal angle and extended down one to two cm inferiorly. It is indicated in cases for hump corrections or mild tip bulbousity where there is adequate tip projection and rotation. (Figs. 5 1,2,3)

    2. Hemitransfixion incision:
      Carried out around the superior septal angle down along caudal septal margin beyond the middle crura-septal attachment. Indicated in cases of hump correction, mild bulbousity and septal deviation where there is adequate tip projection and rotation. (Fig. 17-9)

    3. Complete transfixion incision:
      Carried out bilaterally (through and through) around the superior septal angle and down along caudal septal margin beyond the medial crura-septal attachment but stops above the nasal spine. It is indicated in delivery of the alar cartilage, corrections of hump and septal deviation. Compensatory measures (new dome creation, scoring, suture fixation or Bizrah's modification of vertical

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