Objective/Hypothesis Although minor and major tip support mechanisms have been described in detail, no quantitative models exist to provide support for the relative contributions of the structural properties of the major alar cartilage, the fibrous attachments to surrounding structures, and the rigid support structures in an objective manner. Study Design The finite element method was used to compute the stress distribution in the nose during simple tip compression, and then identify the specific anatomic structures that resist deformation and thus contribute to “tip support”. Additionally, the impact of caudal septal resection on nasal tip support was examined. Method The computer models consisted of three tissue components with anatomically correct geometries for skin and bone derived from CT data. Septum, upper lateral cartilages, and major alar cartilages were fitted within the model using 3D CAD software. 5mm nasal tip compression was performed on the models with caudal septal resection (3mm and 5 mm) and without resection to simulate palpation, then the resulting spatial distribution of stress and displacement was calculated. Results The von Mises stress in the normal model was primarily concentrated along medial crural angle. As caudal septum length was reduced, stress was redistributed to adjacent soft tissue and bone, resulting in less force acting on the septum. In all models, displacement was greatest near the intermediate crura. Conclusions These models are the first step in the comprehensive mechanical analysis of nasal tip dynamics. Our model supports the concept of the caudal septum and major alar cartilage as providing the majority of critical load-bearing support. Level of Evidence N/A
Objective We employ a nasal tip finite element model (FEM) to evaluate contributions of two of the three major tip support mechanism: attachments between the upper and lower lateral cartilages and the attachment of the medial crura to the caudal septum. Study Design The nasal tip FEM computed stress distribution and strain energy density (SED) during nasal tip compression. We examined the impact of attachments between the upper and lower lateral cartilages and the attachment of the medial crura to the caudal septum on nasal tip support. Methods The FEM consisted of three tissue components: bone, cartilage, and skin. Four models were created: A) Control model with attachments present at the scroll and caudal septum; B) Simulated disruption of scroll; C) Simulated disruption of medial crura attachments to caudal septum; D) Simulated disruption of scroll and medial crura attachments to caudal septum. Spatial distribution of stress and SED were calculated. Results The keystone, intermediate crura, caudal septum and nasal spine demonstrated high concentration of stress distribution. Across all models, there was no difference in stress distribution. Disruption of the scroll resulted in 1% decrease in SED. Disruption of the medial crura attachments to the caudal septum resulted in 4.2% reduction in SED. Disruption of both scroll and medial crural attachments resulting in 9.1% reduction in SED. Conclusion The nasal tip FEM is an evolving tool to study structural nasal tip dynamics and demonstrates the loss of nasal tip support with disruption of attachments at the scroll and nasal base.
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