Reducing Dorsal Hump Recurrence Following Push Down-Let Down Rhinoplasty

Abstract

Background Hump recurrence is one of the commonly encountered problems following dorsal preservation rhinoplasty (DP) during the learning period. Objective The aim of this paper is to discuss different methods for the prevention and treatment of dorsal problems following dorsal preservation surgery. Methods One hundred fifty primary rhinoplasty patients were included in our study. The noses were classified as to both hump shape (V- or S-shaped) and height. All patients had a dorsal preservation rhinoplasty with either a push-down (PD) or a let-down (LD) technique. The PD method was used for humps <4 mm and the LD for humps >4mm. Follow up evaluations were made with physical examination and photographs at 1 week, 3 months, and 12 months. Results Mean follow-up was 12.68 ± 1.78 months. 78 humps were V-shaped and 72 were S-shaped. PD was used for 77 cases, LD for 83 cases. 8 patients (5.3%, 8/150) had a visible dorsal hump problem after DP surgery. Based on their preoperative hump shape, 3 cases were V-shaped and 5 were S-shaped. All recurrent cases had a preoperative hump deformity greater than 4 mm. The revision procedures were as follows: 4 patients had PD procedure, 3 had a LD procedure, and one patient was treated by classic open resection rhinoplasty. Conclusion We can say that there is a relatively correlation between preoperative hump height and eventual hump recurrence. The complication rate can be decreased with additional technical maneuvers and proper patient selection.

Guidelines for Dorsum Preservation in Primary Rhinoplasty

“…Tüncel and Aydogdu 6,7 reported that hump recurrences were in > 4mm group, higher the hump, greater the recurrence. The complication rate dropped from 12.1 to 5.3% with additional maneuvers and proper patient selection.…”

“…To understand various parameters related to revision surgery, 7 we also analyzed motivations, duration, type of anesthesia, surgical procedures chosen, and the ease of the surgical intervention.…”

Fixation of the Cartilaginous Vault with Barbed Suture in Closed-Approach High-Septal-Resection Dorsal Preservation Rhinoplasty

“…Several studies have been published on the dorsal fixation technique. Tuncel et al reported the use of a transnasal needle to pass fixation suture through it, which was internally tied over the upper lateral cartilage in closed-approach rhinoplasty 7 . Kosins emphasized the importance of three-point fixation in his study, in which all patients underwent open-approach rhinoplasty 6 .…”

“…After a period of widespread practice by many surgeons, postoperative hump recurrence ("popping up of the dorsum") emerged as a frequent complication 6 . Therefore, fixation of the cartilaginous vault has become an important topic, and different techniques to accomplish this have been described 7 . In the open approach, dorsal fixation sutures can be easily performed.…”

120 Years of Dorsal Preservation in Rhinoplasty

“…10,16,21,[25][26][27][28][29][30][31] Several modifications to the key dorsal preservation techniques have been described in recent years, leading to refinements and improvements in techniques that will help improve outcomes. 23,24,[32][33][34][35] There are vastly more advanced equipment-from crystalclear endoscopes connected to high definition monitors, finer osteotomes and rongeurs, electric drills and burrs to piezoelectric instruments that allow for precision cuts required by the techniques for preservation rhinoplasty. [36][37][38][39] Computed tomography scans and image-processing softwares that allow for preoperative measurements, and intraoperative execution, of the precise amount of bone and cartilage to resect, may enhance surgeons' confidence and improve results.…”