The contemporary teaching that the correction of a saddle nose lacking tip support necessitates the insertion of an L-shaped (hinged) graft is based on the premise that the lobule is supported mainly by the septum.1,3,6,7
The purpose of this paper is to present some evidence to show that this teaching requires revision and that the L-shaped graft has no place in rhinoplastic surgery. Perhaps we can bring our facts into better focus by giving the background of the L-shaped graft, its disadvantages, and the reason why we have abandoned its use for the past 20 years.
The use of the L-shaped graft began in the latter half of the 1800's at a time when rhinoplastic surgeons were beset by many problems, one of which was how to produce a gradually increasing nasal profile projection. Credit for the solution of this problem must be given to von Hacker8
FOMON S, BELL JW, LUBART J, SCHATTNER A, SYRACUSE VR. Saddle Nose and the L-Shaped Graft. AMA Arch Otolaryngol. 1960;71(6):932–937. doi:10.1001/archotol.1960.03770060044006
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: