Complex Nasal Surgery

Polydioxanone plates are absorbable plates used by Dr. Bray, Jr. during complex nasal surgery.  These plates are made of polydioxanone, a substance used in a popular suture.  The plate has many different applications in rhinoplasty surgery.  Dr. Bray, Jr. uses the plate primarily to assist with straightening the crooked nose and in revision cases when the patient has minimal available septal cartilage.

Correcting the crooked nose remains a challenge for plastic surgeons. In many cases of the crooked nose the dorsal or caudal septum is deviated. Open and closed septoplasty techniques have been described to correct nasal deformity. An anatomic reconstruction requires straightening of the deviated dorsal or caudal septum. Depending on the severity and type of deviation different techniques may be used to correct the deviation.

Dorsal deviations are corrected based on the severity and type of deviation. In some cases, grafts of cartilage may be used to camouflage the deviation. In other cases the dorsal septum is straightened. Some techniques used to straighten the dorsal septum include spreader grafts, horizontal mattress sutures, perpendicular plate, cartilage scoring, or asymmetric placement of sutures when reattaching the upper lateral cartilages. In more severe cases the portion of deviated septum may be excised and replaced with spreader grafts. In the most severe cases, the entire septum is removed, reconstructed, and replaced. PDS plates may be used to reconstruct or straighten the septum alone or with some of these techniques.

The caudal septum is treated based on severity and type of deviation. In some cases, simply relocating the caudal septum over the nasal spine will correct the problem. If the caudal septum remains deviated or concave after relocation then techniques used to straighten the cartilage are employed. These include reinforcement with a cartilage grafts, horizontal mattress sutures, and excision of the deviated portion with replacement. In severe cases the septum is removed, reconstructed, and replaced. PDS plates may be used with these techniques to reconstruct or straighten the septum.

PDS plates have also been used with septal extension grafts, columellar struts, and to help straighten the lower lateral cartilages.  At the time of your consultation Dr. Bray, Jr. will discuss the surgical plan in detail.  If the plan includes PDS plates he will discuss the plates and how they will be used in your case. If you have questions or would like to schedule a consultation please call Dr. David Bray, Jr. at (310) 326-9400.