title: Management of intraoperative fractures of the nasal septal "L-strut": percutaneous Kirschner wire fixation.
abstract: BACKGROUND
  The area where the septal cartilage joins the perpendicular plate of the ethmoid is a vulnerable region where overresection or disruption during rhinoplasty causes a loss of support and potential collapse of the nasal dorsum, leading to a saddle-nose deformity. Previously described methods of repair involve suture techniques that are often inadequate to restore septal stability. The authors present the senior author's (J. P. G.) experience in managing intraoperative fractures of the septal "L-strut," describe a classification system for the types of dorsal septal L-strut fractures, and present a new method of treatment using percutaneous Kirschner wire fixation.
  
  
  METHODS
  The authors conducted a retrospective review of 1372 primary and secondary rhinoplasties performed by the senior author. A classification system was developed to describe the type and location of dorsal septal L-strut fractures. Each patient was treated with immediate restabilization of the fractured dorsal septal L-strut with dorsal spreader grafts, percutaneous Kirschner wire fixation, or a combination of both methods.
  
  
  RESULTS
  Seventeen patients sustained an intraoperative fracture of the septal L-strut with an overall incidence of 1.2 percent. Complications included minor dorsal deviation and inadequate reduction/moderate dorsal depression in three patients requiring revision surgery to correct the dorsal deformities.
  
  
  CONCLUSIONS
  An intraoperative fracture of the septal L-strut is a rare but unfortunate occurrence during rhinoplasty. Although technically difficult to perform, the percutaneous Kirschner wire fixation technique with or without spreader grafts is a novel and effective approach to this complication.
authors.affiliation: Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA. drgunter@drjackgunter.com
authors.forename: Jack P
authors.initials: JP
authors.lastname: Gunter
authors.forename: C Spencer
authors.initials: CS
authors.lastname: Cochran
mesh_terms: D001864:Bone Wires; D005593:Fracture Fixation, Internal; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery*; D009300:Nasal Septum / Q000293:injuries*; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000009:adverse effects*