The nose plays a big factor in how good a person looks. In recent years, comprehensive nasal surgery has become more and more common. The choice of cartilage for comprehensive nasal surgery includes ear cartilage, nasal septum cartilage and rib cartilage. However, some patients have congenital short nose and weak nasal septum, and the ear cartilage alone cannot reach the ideal support, and they also refuse to take rib cartilage for the surgery, so what should they do? The sieve bone is located between the frontal bone and the pterygoid bone, the coronal section of this bone is in the shape of a scarf, and the sieve bone is divided into three parts: the sieve plate, the vertical plate, and the sieve labyrinth. The vertical plate of the sieve bone is located in the upper part of the nasal septum, its upper 2/3 part is thick, the lower 1/3 part is thin, and the middle and lower 1/3 parts can be cut as rhinoplasty auxiliary grafts. As shown in the figure below: What criteria should be met before this method can be used? 1. No psychological disorder or mental illness, able to express his/her will clearly; 2. Good skin elasticity, able to stretch sufficiently, with a low nasal bridge and obvious exposed nostrils. How can the sieve bone vertical plate removal be safely and effectively used in rhinoplasty? During sieve bone vertical plate removal, an endoscope is inserted, and the cartilage membrane is peeled off microscopically, so that the nasal septum cartilage is fully exposed in the artificially formed working space, and the nasal septum cartilage, the vertical plate of the sieve bone, the pearly bone and the palatal ridge can be revealed. Figure 1 endoscopic exposure of the nasal septal cartilage Figure 2 endoscopic exposure of the vertical plate of the sieve bone The results of the surgery are also very impressive The preparation time before endoscopic surgery is 5~10min, and the time needed for endoscopic cutting of the vertical plate of the sieve bone is 3~5min, and endoscopic surgery can clearly and intuitively show the anatomical structure of the vertical plate of the sieve bone in the operative area and its adjacency to the septal cartilage and the pterygoid bone and other peripheral organs, especially the posterior part of the vertical plate of the sieve bone. Especially the posterior part and the bottom of the vertical sieve plate, which are difficult to be observed under direct vision, can be clearly visualized. The amount of the vertical plate of the sieve bone is sufficient (as shown below). The vertical plate of the sieve bone and the nasal septum cartilage are removed in the traditional rhinoplasty, which is done under blind vision. Due to the narrow field of vision, the vertical plate of the sieve bone can not be clearly revealed, and it can only be removed by personal experience and feeling, which can not ensure that the vertical plate of the sieve bone is sufficiently removed, and it is easy to cause fractures of the base of the skull if the force is not properly grasped, If the strength is not properly controlled, it is also easy to cause skull base fracture, cerebrospinal fluid leakage and hemorrhage. Advantages of endoscopic-assisted vertical sieve plate removal: ① the same incision as the nasal comprehensive surgery, no additional incision, and no intraoperative incision lengthening and mucous membrane tear; ② a clear field of vision, clear separation and removal of the vertical sieve plate, and adequate hemostasis; ③ endoscopic assistance, can be operated under direct vision to remove the vertical sieve plate of the appropriate area of weakness, and it is not easy to damage the base of the skull, resulting in cerebrospinal fluid leakage; ④ The vertical plate of the sieve bone sometimes produces bone tips or spurs after partial removal, and the endoscope can not only observe whether the trauma is bleeding or not after removal, but also find and remove sharp bone spurs, effectively preventing secondary injuries such as septal hematoma and septal mucous membrane perforation of medical origin. Relevant cases: preoperative lateral position and 6 months postoperative lateral position We all know that rhinoplasty can solve a variety of nasal problems at one time, if you refuse to take the rib cartilage for the operation, you can use endoscopic sieve bone vertical plate excision, but also eliminate the incision of taking rib cartilage. But the premise is to go to the regular professional medical institutions, choose experienced professional plastic surgeon, the doctor must master the use of endoscopy and familiar with the sieve bone vertical plate of the anatomical structure and adjoining relationship; not only do we try to protect the integrity of the nasal mucosa, but also pay attention to some parts of the cartilage can not be arbitrarily resected, because we need to ensure that the remaining septal cartilage of the stability of the dorsal cartilage to prevent the dorsal cartilage section of the nose collapsed.