Endonasal FLI Approach for Rhinoplasty with Modified Cottle Low Strip Septoplasty

Overview

The authors state no endonasal approach has previously been described that combines incisions to expose all the key structures at once. The technique, designed by Fausto Lopez-Infante, brings together several known incisions inside the nose to give a view of the full septal cartilage, its junction with the upper lateral cartilages, the lower and front septal borders, the scroll region and the internal nasal valve.

Sections of note

• Technique description; the abstract reports no patient numbers, no outcomes, no complication rates and no follow up.
• The approach combines several basic known endonasal incisions.
• Stated exposure includes the complete quadrangular cartilage and its extension with the upper lateral cartilages.
• It also exposes the caudal septal border from the ventral border and anterior nasal spine to the anterior septal angle, plus the scroll and the internal nasal valve.
• The authors state it enables extensive septal work.
• It is said to preserve the natural anatomy of the bridge and the tip support structures.
• The authors state the approach standardizes the surgery and makes it reproducible.

What it means for a patient

• Endonasal means all incisions are inside the nose, leaving no external scar on the columella.
• The claimed advantage is that the surgeon can see and work on the septum fully without an open approach.
• Claims of excellent cosmetic and functional results carry no supporting data in the abstract.
• No comparison against the open approach or other endonasal techniques is presented.

Why this paper matters

The open approach became dominant partly because it gives direct view, and endonasal techniques have been argued to trade exposure for reduced disruption. This article claims an endonasal route with full exposure. Whether results match the open approach has not been tested here.

Terms

• Endonasal approach: surgery through incisions inside the nose only.
• Quadrangular cartilage: the main flat plate of septal cartilage.
• Upper lateral cartilages: the paired cartilages forming the middle third of the nose.
• Scroll: where the upper cartilages overlap the tip cartilages.
• Internal nasal valve: the narrowest part of the nasal airway.
• Anterior nasal spine: the small bony projection at the base of the nose.