Treatment of Hyperdynamic Nasal Tip Ptosis in Open Rhinoplasty: Using the Anatomic Relationship Between the Depressor Septi Nasi Muscle and the Dermocartilaginous Ligament

Abstract Background Musculus depressor septi nasi and its tendon, the dermocartilaginous ligament, play an important role in external nasal valve and nasal respiration. If the ligament is cut during septorhinoplasty operations, nasal functions of the nose and facial expressions are affected. Therefore, the aim of this study was to investigate the role of M. depressor septi nasi in nasal respiration at open rhinoplasty operations using rhinomanometry and electromyography. Methods The study included 29 patients who had only external nasal deformity (nasal hump deformity). All patients underwent open rhinoplasty. The dermocartilaginous ligament of the patients in the study group (DCL + group) was repaired but not in the control group (DCL − group). Rhinomanometry and electromyography were applied to all patients preoperatively and postoperatively. Results In the DCL − group, right and left nasal airflow values were significantly lower in post-op (562.92 cm3/s and 548.57 cm3/s), whereas right, left, and total nasal resistances were significantly lower in pre-op (0.28 Pa/cm3/s, 0.22 Pa/cm3/s, and 0.11 Pa/cm3/s). Statistically significant differences were not found between rhinomanometric measurements in pre-op and post-op values of the DCL + group. Post-op right, left and mean values of M. depressor septi nasi amplitude in the DCL + group (2.05 mV, 2.0 mV, 2.02 mV) were significantly higher than those in the DCL − group (1.52 mV, 1.61 mV, 1.57 mV). Conclusion Repair of the dermocartilaginous ligament during open rhinoplasty operations enhances nasal respiratory functions by expanding the external nasal valve through M. depressor septi nasi and allows the nose to participate in mimic movements. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Download Full-text

Management of the nasal tip by open rhinoplasty

Journal of Cranio-Maxillofacial Surgery ◽

10.1016/s1010-5182(96)80047-3 ◽

1996 ◽

Vol 24 (3) ◽

pp. 145-150 ◽

Cited By ~ 10

Author(s):

G. Raspall ◽

J. González-Lagunas

Keyword(s):

Open Rhinoplasty ◽

Nasal Tip

Download Full-text

Open Rhinoplasty

10.2310/ps.10046 ◽

2020 ◽

Author(s):

Ginger Xu ◽

Paul Hwang ◽

Nargiz Seyidova ◽

Samuel J. Lin

Keyword(s):

Key Words ◽

Preoperative Evaluation ◽

Surgical Techniques ◽

Postoperative Management ◽

Black Box ◽

Open Rhinoplasty ◽

Nasal Tip ◽

Nasal Anatomy ◽

Nasal Function ◽

Type Of Surgery

Rhinoplasty is often considered the black box of plastic surgery. This apprehension can be overcome by having a fine-tuned understanding of nasal anatomy, developing an appreciation for nasal aesthetics, and becoming well-versed in the array of surgical techniques available to address specific cosmetic and functional concerns. Technical care and finesse are required in this type of surgery, where even 1 mm of change can result in a profound difference. Nasal function must also be assessed and preserved during rhinoplasty. Aside from these technical points, it is equally important to accurately and thoroughly understand each patient’s goals and to communicate the realistic outcomes and limitations of what can be done through surgery. Key words: open rhinoplasty, nasal anatomy, nasofacial analysis, rhinoplasty techniques, rhinoplasty preoperative evaluation, rhinoplasty postoperative management, lateral nasal osteotomies, nasal tip grafts, nasal tip suture techniques This review contains 23 figures, 2 tables, and 43 references.

Download Full-text

Open rhinoplasty using a columellar strut: effects of the graft on nasal tip projection and rotation

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-020-05836-9 ◽

2020 ◽

Vol 277 (5) ◽

pp. 1371-1377 ◽

Cited By ~ 2

Author(s):

S. Bucher ◽

S. Kunz ◽

M. Deggeller ◽

D. Holzmann ◽

M. B. Soyka

Keyword(s):

Open Rhinoplasty ◽

Nasal Tip ◽

Tip Projection ◽

Columellar Strut ◽

Nasal Tip Projection

Download Full-text

Use of 2-Octylcyanoacrylate (Dermabond) Tissue Adhesive for Tip Graft Fixation in Open Rhinoplasty

Otolaryngology ◽

10.1177/0194599811419094 ◽

2011 ◽

Vol 145 (5) ◽

pp. 737-741 ◽

Cited By ~ 7

Author(s):

Jin-Young Min ◽

Yong Ju Jang

Keyword(s):

Complication Rate ◽

Soft Tissues ◽

Costal Cartilage ◽

Tertiary Care ◽

Case Series ◽

Tissue Adhesive ◽

Open Rhinoplasty ◽

External Approach ◽

Cartilage Grafts ◽

Nasal Tip

Objectives. To describe the use of 2-octylcyanoacrylate (2-OCA; Dermabond) for fixation of cartilage grafts in nasal tip surgery via an external approach in Asian patients. Study Design. Case series with chart review. Setting. Academic tertiary care medical center. Subjects and Methods. This retrospective study analyzed data from 33 Korean patients who underwent open rhinoplasty using 2-OCA tissue adhesive for fixation of cartilage grafts in tip surgery. Autologous septal, conchal, costal, or homologous costal cartilage was used as graft materials. Layers of cartilages were bonded using 2-OCA tissue adhesive, and care was taken to prevent the tissue adhesive from spilling and directly contacting surrounding soft tissues. Preoperative and postoperative photographs were reviewed for objective and subjective assessment of aesthetic outcomes. Results. Postoperative aesthetic outcomes were graded as excellent in 51.5%, fair in 33.3%, and no change/worse in 15.2% of patients. Preoperative and postoperative anthropometric measurements showed that the nasal tip projection increased (0.53 ± 0.03 vs 0.57 ± 0.05; P < .05) and the nasolabial angle improved (92.54 ± 6.95 vs 96.12 ± 5.20; P < .05). The overall complication rate was 24.2%, and complications included erythema (9.1%), infection (12.1%), and aesthetic dissatisfaction (3.0%). Conclusion. Although using 2-OCA tissue adhesive for tip surgery simplifies the surgical procedures of fixating graft materials, the relatively high complication rate may preclude its use in nasal tip surgery via an external approach for Asian noses.

Download Full-text

The Comparison of the Long-Term Efficiency of Short Columellar Strut Graft and Suture Techniques on Maintaining Nasal Tip Projection and Nasolabial Angle Following Primary Open Rhinoplasty

Istanbul Medical Journal ◽

10.4274/imj.galenos.2021.70481 ◽

2021 ◽

Vol 22 (4) ◽

pp. 261-266

Author(s):

Dinçer Altınel ◽

Gaye Toplu ◽

Merdan Serin

Keyword(s):

Suture Techniques ◽

Open Rhinoplasty ◽

Strut Graft ◽

Nasal Tip ◽

Tip Projection ◽

Columellar Strut ◽

Nasolabial Angle ◽

Columellar Strut Graft ◽

Nasal Tip Projection

Download Full-text

Cephalic lateral crural advancement flap

Archives of Plastic Surgery ◽

10.5999/aps.2020.01648 ◽

2021 ◽

Vol 48 (2) ◽

pp. 158-164

Author(s):

Fuat Bulut

Keyword(s):

Analogue Scale ◽

Advancement Flap ◽

Open Rhinoplasty ◽

Nasal Patency ◽

Lower Lateral Cartilage ◽

Lateral Crus ◽

Tip Rotation ◽

Nasal Tip ◽

The Mean

Background In lower lateral cartilage (LLC) surgery, cephalic trimming poses risks for the collapse of the internal and external nasal valves, pinched nose, and drooping deformity. The cephalic lateral crural advancement (CLCA) technique presented herein was aimed at using a flap to increase nasal tip rotation and support the lateral crus, in addition to the internal and external nasal valves, by avoiding grafts without performing excision.<br/>Methods This study included 32 patients (18 female and 14 male) and the follow-up period for patients having undergone primer open rhinoplasty was 12 months. The LLC was elevated from the vestibular skin using the CLCA flap. A cephalic incision was performed without cephalic trimming. Two independent flaps were formed while preserving the scroll ligament complex. The CLCA flap was advanced onto the lower lateral crus while leaving the scroll area intact. The obtained data were analyzed retrospectively.<br/>Results The mean age of the patients was 31.6 years (range, 20–51 years). The Rhinoplasty Outcome Examination scores after 12 months varied from 90 to100 points, and 93% of patients reported perfect satisfaction. At a 1-year follow-up, the patients’ nasal patency (visual analogue scale) rose from 4.56±1.53 (out of 10) to 9.0±0.65 (P<0.001).<br/>Conclusions The CLCA flap led to better nasal tip definition by protecting the scroll area, increasing tip rotation, and supporting the internal and external nasal valves without cephalic excision.

Download Full-text

Narrowing the Wide Tip via Endonasal Approach

Facial Plastic Surgery ◽

10.1055/s-0041-1735561 ◽

2021 ◽

Author(s):

Omotara Sulyman ◽

Steven Dayan

Keyword(s):

Healing Time ◽

Open Rhinoplasty ◽

Endonasal Approach ◽

Nasal Tip ◽

Nasal Anatomy ◽

Facial Plastic ◽

The Aesthetic ◽

Contractile Forces ◽

Tip Rhinoplasty ◽

Gain Access

AbstractRhinoplasty is arguably the most complex and intricate surgery performed by facial plastic surgeons. Nasal tip refinement of a broad nasal tip has remained the most challenging part of rhinoplasty as sophisticated techniques are critical to achieve aesthetically pleasing and structurally sound nasal tips that can withstand the contractile forces of healing. Successful tip refinement relies on an in-depth preoperative and intraoperative understanding of the patient's nasal anatomy, well developed arsenal of techniques, the experience of the surgeon, and the aesthetic desires of the patient. Although the approach to gain access to the nasal tip so as to successfully reshape the tip has been a topic of debate over many years, the aim of this article is to outline and demonstrate how the broad nasal tip can be successfully recontoured through an endonasal approach using nondestructive techniques that have been effectively used in open rhinoplasty. We believe that there continues to be a place for endonasal tip rhinoplasty especially in this era in which patients desire less invasive procedures with shorter healing time.

Download Full-text