title: A Model to Estimate L-Strut Strength With an Emphasis on Thickness.
abstract: OBJECTIVE
  To perform and teach septorhinoplasty, one must have a principled understanding of the mechanics of the nasal septum. The thickness of the L-strut and how it changes septal strength have not been adequately quantified, yet calculating septal strength based on changes to thickness and size is vital in maintaining lasting nasal strength and integrity.
  
  
  OBJECTIVE
  To establish standards for the nasal septal cartilage thickness, dorsal and caudal septum length, and Young's modulus. To provide a basis for quantitative, operative decision making, a mathematical model of L-strut strength is presented based on changes in thickness and width.
  
  
  METHODS
  Nasal septal cartilages from 30 fresh cadavers were used to measure thickness at clinically relevant points and length of dorsal and caudal L-strut arms. The Young modulus was directly measured using a force gauge. Statistical analyses were performed to compare thicknesses in anatomically relevant areas. Using a cantilevered beam construct, the spring constant of the L-strut dorsal and caudal arms were estimated individually with width and thickness as variables.
  
  
  METHODS
  Thickness, dorsal and caudal length, and the Young modulus of nasal septal cartilage. Spring constants of dorsal and caudal L-strut arms with different combinations of thickness and width.
  
  
  RESULTS
  The mean (SD) age at death of the 30 cadavers was 79.2 (13.6) years (range 50-97 years). Of these, 17 (57%) were male, and 13 (43%) were female. The mean (SD) nasal septal cartilage thickness in the 30 cadavers was 1.45 (0.54) mm. Mean (SD) thickness of points along the 2-mm L-strut line was 1.49 (0.56) mm and was significantly thicker than points along the 5-mm L-strut line (mean [SD] thickness, 1.29 [0.52] mm) but significantly thinner than points along the 15-mm L-strut line (mean [SD] thickness, 1.68 [0.53]). Mean (SD) thicknesses of the posterior dorsal and caudal cartilage points were 1.52 (0.45) mm and 1.71 (0.69) mm and were significantly thicker than the anterior dorsal and caudal points (mean [SD] thickness, 1.28 [0.42] mm and 1.31 [0.44] mm, respectively). Mean (SD) dorsal and caudal L-strut arm lengths were 21.9 (3.7) mm and 20.9 (3.5) mm, respectively. The mean (SD) Young modulus was 2.03 (1.3) MPa. A model was generated demonstrating the thickness required to maintain a desired strength at a given dorsal or caudal arm width.
  
  
  CONCLUSIONS
  Although thickness was not uniform throughout the nasal septum, there is a predictable pattern. Thickness of the L-strut contributes more to septal strength than does L-strut width. The model generated in this study can be used in planning, performing, or teaching the applied mechanics of septorhinoplasty.
  
  
  METHODS
  NA.
authors.affiliation: Loma Linda University School of Medicine, Loma Linda, California.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Paul
authors.affiliation: Loma Linda University School of Medicine, Loma Linda, California.
authors.forename: Kelton
authors.initials: K
authors.lastname: Messinger
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California.
authors.forename: Yuan F
authors.initials: YF
authors.lastname: Liu
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California.
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Kwon
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California.
authors.forename: Cherine H
authors.initials: CH
authors.lastname: Kim
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California.
authors.forename: Jared C
authors.initials: JC
authors.lastname: Inman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D003657:Decision Making; D055119:Elastic Modulus; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D055171:Nasal Cartilages / Q000033:anatomy & histology* / Q000502:physiology / Q000601:surgery; D009300:Nasal Septum / Q000601:surgery; D012225:Rhinoplasty