Reconstructing the keystone area
Reviewed by Eduardo Morera Serna

This manuscript describes two different ways to stabilise the keystone area during extracorporeal septoplasty. The authors performed a retrospective study on 110 patients who were operated for extracorporeal septoplasty by multiple surgeons. The patients were divided into two groups; in the first group, the keystone area was stabilised either by criss-cross suture or percutaneous suture; in the second group, superior fixation of the neoseptum was performed in the traditional way suturing it to the upper lateral cartilages. The criss-cross technique was performed on patients with long nasal bones while the percutaneous technique was chosen for patients with short bones. No patient needed revision surgery in group one while the revision rate in group two was 9.6%. There was a statistically significant difference between both groups. Extracorporeal septoplasty is a highly technical and demanding procedure. Secondary saddling is a common complication after this procedure due to the postoperative sinking of the osteocartilaginous junction caused by keystone area instability. These two ingenious ways to stabilise the neoseptum attachment to the bony vault achieve a complete resolution of this problem. A great article for rhinoplasty surgeons.

New suturing techniques to reconstruct the keystone area in extracorporeal septoplasty.
Rezaeian F, Gubisch W, Janku D, Haack S.
PLASTIC AND RECONSTRUCTIVE SURGERY
2016;138(2):374-82.