Anatomic Reconstruction of the Nasal Tip Cartilages in Secondary and Reconstructive Rhinoplasty

Abstract

The conventional designation of septal pathology is a deviated septum, and the common treatment of choice is submucous resection of the septum. These limited generic terms leave the surgery open to frequent failure and render the education of this topic suboptimal. During 1224 septal surgeries, we have observed six different categories of septal deviation requiring different surgical treatments. A study was conducted to investigate the frequency of different classes of septal deviation and to develop guidelines for a more successful surgical correction of each category. Ninety-three consecutive patients who underwent septoplasty were carefully evaluated for the type of septal deformity, age, gender, history of trauma, and previous septal surgery. The surgical technique was reviewed for each category of the septal deformity. Of the 93 patients, 71 were women and 22 were men. Ages ranged from 13 to 76, with an average age of 31.5. Most patients exhibited a "septal tilt" deformity (40 percent; 37 of 93) or a C-shape anteroposterior deviation (32 percent; 30 of 93). The other deformities were C-shape cephalocaudal (4 percent; 4 of 93), S-shape anteroposterior (9 percent; 8 of 93), S-shape cephalocaudal (1 percent; 1 of 93), or localized deviations or large spurs (14 percent; 13 of 93). Each of the six categories of septal deviation requires specific management. If a single procedure is selected for all of the septal deformities, disappointing results may ensue.

Lateral Crural Transposition Flap in Tip Correction

“…1 Cartilage incising or excising techniques used in rhinoplasty operations might lead to the interruption of the LLCs and loss of skin envelope support, which will in turn cause an aesthetic problem as well as a functional deficit associated with it, as it influences the patency of external nasal valve. McCollough and Fedok 8 first described the lateral crural turnover graft that involved excising a cephalic strip of the LLC and turning it over onto the concave LLC.…”

Analyzing Nasal Septal Deviations to Develop a New Classification System

“…The present study has some of the same limitations as in previous studies, including image distortion and insufficient resolution to visualize specific structures. However, many of the features used in previously reported 5–7,9,10 septal deviation classification systems were readily visualized and observed using the virtual endoscopy feature, thus pointing to the ability of a classification system to incorporate both data obtained through CT analysis and virtual endoscopy findings.…”

“…Mladina 5 characterized septal deviations according to 7 patterns of deviation along various axes, a system that was modified by Rao et al 6 to provide additional structural information. Guyuron et al 7 used a 6-tiered system based on a C- or S-shaped septum as viewed from multiple orientations surgically. One of the challenges with these classification methods is the limited ability to precisely localize areas of deformity.…”

A Novel Approach to Cleft Lip Nose Deformity

“…However, augmenting cartilage grafts is far from being anatomic and functional. 8 It provides only camouflage. The suture manipulations are not sufficient, and they make the external nasal valve narrower on its own (Fig 2).…”

“…Tip aesthetic is determined by the shape, size, and position of alar cartilages. 8 For this reason, methods put forward for the treatment usually focus on the nasal tip area.…”