Resumo

Objectives: In preservation rhinoplasty subdorsal hump resection without clear visualization, may leave a subdorsal cartilaginous stump. This stump is a frequent cause of residual and/or, hump recurrence duo to natural cartilage convexity. Also, inaccurate blind resection of subdorsal perpendicular plate of ethmoid (PPE) could be other cause of residual or recurrent hump. The modified dorsal split technique with bilateral septal T incisions may cause keystone area disruption. Introduction: Subdorsal cartilage and bone (PPE) resection under vision with total preservation of osseocartilaginous interconnection at the dorsal keystone area. Materials / method: One side component separation of septal T, controlled accurate resection of subdorsal cartilage strip and wedge of ethmoid bone under direct vision in a series of 53 patients with follow up of one year. Results: All patients presented favorable outcomes with natural looking dorsum. Fine tuning of septum deviation and upper lateral cartilage adjustment were possible Conclusion: Disrupting the keystone area is a fraught complication that may require secondary revision. One side component separation of septal T is a safe method that protect against keystone area separation. Also, it is an accurate method to do controlled subdorsal cartilage and bone resection.