Background
Classic nasal hump reduction based on partial resection of the cartilage and bones in the nose may lead to dorsum deformities such as an inverted-V deformity, irregularities, and an open roof. Techniques that preserve the nasal dorsum (namely the push-down and let-down) avoid these problems, but may not always be indicated for very large, broad, or deviated noses, whereas cartilaginous push-down is also indicated for large and deviated humps. Because only the cartilaginous portion of the hump is preserved in the cartilaginous push-down, a rough area may remain where the bony portion is resected.
Objectives
The aim of this study was to develop a variation of the cartilaginous push-down technique which includes a bony cap to preserve the smoothness of the keystone area during nasal hump treatment.
Methods
Forty-eight consecutive patients with indication for nasal hump treatment who underwent cartilaginous push-down procedures with bony cap preservation between August 2018 and October 2019 were studied.
Results
We observed related complications in 2 patients (4.2%); in 1 patient (2.1%) the bony cap was lost during the rasping of the nasal bones and the surgery was altered to utilize only the cartilaginous push-down. Another patient (2.1%) experienced a mild hump recurrence during the early weeks following the procedure. All of the remaining patients had their nasal humps treated adequately.
Conclusions
The nasal hump was adequately corrected in most of the study patients (95.8%). Preserving the bony cap while performing the cartilaginous push-down may prevent complications related to the osseous resection of the keystone area.
Level of Evidence: 4
The cartilaginous structures of the nose play an important role in nasal esthetics and function. The handling of these structures has always been very treacherous, and long-term follow-up quite often has shown unexpected results. Based on Gibson's studies, we propose the use of abrasion treatment of the nasal cartilages with the burr power drill. This device can produce controlled weakening on determined regions of the nasal cartilages. If this weakening is done on just one side, the cartilage will bend to the opposite side. On the septal cartilage, this method can be used to straighten it by abrasion on its concave portion. To correct the alar cartilages, the burring is done either to enhance curvatures or to change the conformation of the alar cartilage itself. This method was used in 67 patients with satisfactory results, permitting corrections of septal deviations with very little resections of the septal cartilages and corrections of various tip deformities, with almost no resections at all of the alar cartilages.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.