Principles for correcting the septum in septorhinoplasty: two-point fixation

This article describes the principles which enable a bent septum to be corrected without the loss of tip or supratip support. These principles centre on the need for two points of fixation in order to provide adequate stability for the septal cartilage. These points include the maxillary spine, the vertical plate of the ethmoid bone (at least 4 mm in continuity with the septal cartilage), the vomer, the maxillary crest or suspension from the upper lateral cartilages. A columella pocket offers additional support but cannot be regarded as a primary anchoring point. An adequate height from the maxillary spine to the tip (approximately 28 mm) and dorsal length (24 mm) of cartilage are also needed to support the nasal dorsum. The main strategy for correcting a septal bend which is apparent externally, or a supratip depression is described and centres on the use of cartilage grafts to disguise any assymmetry.