Dorsal L-Strut Width after Closed Septal Cartilage Harvest Using Ballenger Swivel Knife
After any procedure involving removal of nasal septal cartilage, the remaining cartilaginous structural framework must retain adequate structural integrity to support the nasal dorsum and prevent collapse. The necessary shape and size for the resulting framework remains debated. A minimum requirement of 8-10mm of dorsal cartilage has been traditionally accepted. Recently, contemporary open rhinoplasty experts advocate for 15mm or greater of dorsal strut width. While many techniques exist, closed septal cartilage harvest with a Ballenger swivel knife offers many advantages, including reliable preservation of adequate nasal support. The swivel knife's capacity to preserve the commonly described "L-strut" has never been quantitatively studied. The purpose of this study was to quantify the remaining dorsal nasal cartilage after aggressive septal harvest with a Ballenger swivel knife.
Methods/Technique:
Ten cadaver heads were procured for evaluation. A standardized closed approach through a Killian incision was used to access the septum. This was followed by bilateral mucoperichondrial elevation. Septal cartilage was harvested from all cadavers in the standard fashion, parallel to the nasal dorsum, using a 3 mm wide Ballenger swivel knife. No technique modification was employed to conservatively harvest dorsal cartilage, instead the surgeon was instructed to harvest as much cartilage as possible. After harvesting the septal cartilage, each nose was then widely opened to expose the remaining septum and a caliper was utilized to measure the width of the narrowest segment of the resultant dorsal cartilage support.
Results/Complications:
Closed septal harvest was performed on nine Caucasian cadaver heads as described. Five males and four females were utilized. One cadaver had a previous septal perforation, therefore was excluded. Median L-strut width was 10mm with a mean of 9.8 mm and range of 6-12 mm.
Conclusion:
On average, our use of a Ballenger swivel knife in closed nasal septal harvest left a 9.8 mm dorsal septal cartilaginous strut. While the clinical impact of dorsal L-strut width in rhinoplasty remains debated, our findings suggest that harvesting septal cartilage with a swivel knife is a safe, quick and reliable technique for septal harvest.