Modified Cartilage Sparing Tip Plasty Technique for Extra Projection: Hemitransdomal Suture With Submucosal Dissection: A New Approach to Nasal Tip Dynamics

Abstract

The nasal tip projection and rotation to be obtained with tip plasty play a key role in achieving successful results. Cartilage sparing techniques provide extra ease to reshape the cartilage in revision rhinoplasty. Freed dome cartilage eliminates the restricting forces of mucosa. The authors recommend to free the dome cartilage from mucosa during the tip plasty which ensures the desired dome shape and extra projection. A total of 218 patients who were operated between the dates of January 2017 and August 2018 were included in this study. About 3 mm parts of the marked domes toward medial and lateral crurae were dissected from the mucosa. New domes were created with bilateral hemitransdomal sutures. The outcome of the operation was asked to the patients verbally and answers were recorded. Of 218 patients who were included in the study, 182 were females and 36 were males. Patients had a mean age of 26.5 years. The length of follow-up was 11.8 months. About 205 patients had primary rhinoplasty while 12 patients had secondary rhinoplasty and 1 patient had revision rhinoplasty. Of the patients, 89.9% (196/218) were very satisfied with the result and 7.4% (16/218) were satisfied, whereas 2.7% (6/218) were dissatisfied. Only 5 patients who were dissatisfied with the result underwent revision rhinoplasty operation. The combination of the modified free dome suture with the mucosal dissection in dome area provides achieving the desired tip projection and symmetry.

Nazal Valv ve Tip Stabilitesini Korumak Amacıyla Modifiye Sliding Alar Kartilaj Tekniği Uygulanan Hastaların Retrospektif Analizi

“…Yaş ortalaması 29,6 (18-58) yıldı. Takip süresi ortalama 14.5 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) aydı. Hastaların 14' ü sadece burun şeklinden şikayetçiyken, 11 hastada hem burun şeklini beğenmeme hem de nefes almakta güçlük şikayetleri mevcuttu.…”

“…Burun ucu projeksiyonu ve rotasyonunun kararlaştırıldığı bu aşama, burun şeklinin son halinin elde edilmesinde en önemli aşamayı oluşturmaktadır. [6][7][8][9] Burun ucundaki bulböziteyi azaltmak amacıyla en sık uygulanan ve en etkin yöntem alt lateral kıkırdağın lateral ve middle segmentlerinden sefalik eksizyonudur. 10,11 Sefalik eksizyon esnasında lateral segmentin 5 mm den daha dar planlanması, hava akımına karşı en fazla direncin gözlendiği eksternal nazal valvte zayıflamaya ve solunum problemlerine neden olmaktadır.…”

A Novel Approach to Provide Long-Term Tip Projection and Rotation Stability: Lateral Columellar Strut Graft

“…[5][6][7][8] However, different techniques, such as suture techniques, tip grafts, or strut grafts, may be preferred to increase tip projection or rotation. [9][10][11][12][13][14][15] Columellar strut graft is one of the most common3ly preferred methods for providing tip support, rotation, and projection 5,15,16 Generally, septal cartilage obtained during septoplasty is placed in the pocket prepared between the medial crus of the lower lateral cartilage and fixed by suturing to the medial crus. During the detection of strut placed between medial crus, divergence angle between domes can be narrowed considerably.…”

“…Especially in open rhinoplasty, the restoration of these anatomical structures is effective in obtaining the desired tip support and rotation 5–8 . However, different techniques, such as suture techniques, tip grafts, or strut grafts, may be preferred to increase tip projection or rotation 9–15 …”