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Research
Elliptical Horizontal Excision and Repair of Alar Cartilage in Open- Approach Rhinoplasty to Correct Cartilaginous Tip Deformities
H. Massiha
(East Jefferson General Hospital, New Orleans, LA; Louisiana State University, New Orleans)
Reprinted from
YEARBOOK OF PLASTIC, RECONSTRUCTIVE & AESTHETIC SURGERY
St. Louis
pp. 239-241, 1999 (Copyright 0 1999 by American Society for Aesthetic Plastic Surgery, Inc. (Printed in the U.S.A.)
Elliptical Horizontal Excision and Repair of Alar Cartilage in Open- Approach Rhinoplasty to Correct Cartilaginous Tip Deformities
Massiha H
(East Jefferson Gen Hosp, New Orleans, La; Lousiana State Univ, New Orleans)
Plast Reconstr Surg 101: 1 77-184, 1998 4-59
Introduction. - Open-approach rhinoplasty has significantly improved correction of nasal tip deformities, particularly bulbous tip deformities. Like double-dome deformities, bulbous deformities are usually cartilaginous in nature, rather than fibrous. Patients with these deformities may need direct alterations of the cartilage, traditionally by resection of the cephalic part of the lateral crura of the lower lateral cartilage.
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FIGURE l.-Above, basic concepts of elliptical excision and repair of the lateral crura of the lower lateral cartilage. Below, reduction convexity of the lateral crura. (Courtesy of Massiha H: Elliptical horizontal excision and repair of alar cartilage in open-approach rhinoplasty to correct cartilaginous tip deformities. Plast Reconstr Surg 101:177-184, 1998.) |
The authors report an experience with elliptical, horizontally directed excision of the central segment of the lower lateral cartilage for the correction of nasal tip deformities (Fig 1).
| Technique.-Elliptical excisions are placed in a horizontal direction in the central segment of the lower lateral cartilage. The width and shape of the elliptical excisions are determined by the anatomy and extent of the deformity, but a 2-3 mm excision is sufficient in most cases. The upper and lower edges of the remaining cartilage are repaired with 3-4 5-0 nylon sutures. These excisions eliminate the most protruding and bulbous portions of the lateral crura. Suturing of the upper and lower portions results in a flatter and narrower lateral crura. The bulge of the dome can be changed at the top, if necessary, with preservation of the relationship between the upper and lower lateral cartilage. The author presents 2 cases in which this procedure corrected bulbous deformities of the nasal tip. |
Conclusions.-An elliptical horizontal excision approach to correction of cartilaginous deformities of the nasal tip is reported. In the author's experience, this technique provides consistently satisfactory clinical results. With any shape of central excision, no free or loose edges of cartilage are left to warp or deform during healing.
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This is an interesting approach because it follows the principal of the diagnosis
of the anatomy as the shown pictures indicate that the maximum amount of bulk
is in the midportion of the alar cartilage. The necessity for a long taper to
prevent buckling of this cartilage, however, means that the incision must be
tapered toward the piriform. This is probably what causes alar retraction seen
in the lateral photographs. Reshaping techniques would not leave a space, and
hence, no retraction. Cephalic resections limited to the domal area leave a
space, but that technique has less cephalic retraction unless it too is carried
toward the piriform. This type of resection also changes the angle that the
cephalic border makes with the septum.
P.W.
McKinney, M.D.
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