Treatment of the Nasal Hump with Preservation of the Cartilaginous Framework

Ishida, Jorge; Ishida, Luiz Carlos; Ishida, Luís Henrique; Vieira, José Cássio Rossi; Ferreira, Marcus Castro

doi:10.1097/00006534-199905000-00029

Cited by 8 publications

(16 citation statements)

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“…While it appears a logical assumption that function would not be compromised in the CPD approach, this could be an issue in FLD procedures where the likelihood of airway compromise has been an initial concern. Several studies however reported positive functional outcomes with dorsal preservation, 4,8,10,14,31,[35][36][37][38][39] although in all instances the osseocartilaginous vault had been mobilized as a single unit. Our technique differs, since it implies a dorsal split and subsequent resuture (►Fig.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6] Common to all of those, whether founded on surface or foundation techniques 7 and applying, symmetrically or not, a pushdown or letdown mobilization of the nasal pyramid on circumferential impaction osteotomies, is the key concept of preserving the whole nasal dorsum intact. A notable exception was that of a pushdown limited to the cartilaginous dorsum or extended to the bony cap, combined with conventional osteotomies of the bony vault, as described by Ishida et al [8][9][10][11] Although PR was described under a closed approach, it was also performed open by many, with the benefit of full visualization, precise piezo osteotomies, and piezo or burr osteoplasty, 12,13 together with the advantage of possibly combining with a structural approach to the tip. 3,4,14 This contemporary concept essentially constitutes a "hybrid" preservation-structural approach.…”

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confidence: 99%

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Modified Dorsal Split Preservation Hybrid Rhinoplasty for Cartilaginous Pushdown and Full Letdown Applications: A PROM-Based Review of 100 Consecutive Cases

Robotti¹,

Cottone

Leone³

2023

Facial Plast Surg

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Splitting the middle vault on an anatomical plane along the “Septal T” allows a new hybrid perspective on the many modifications of “surface” preservation techniques. The “dorsal split preservation” concept can be applied both to cartilaginous pushdown as well as to full letdown techniques. The dorsal keystone area (DKA) is maintained, while the middle vault is reshaped. The septum is addressed by conventional L strut septoplasty. Precise direct suture fixation of the high-middle strip is easily accomplished after flexing the osseous-chondral junction at the K area. Specific technical points are described to allow exact and stable configuration of the dorsum. A retrospective analysis on 100 consecutive patients demonstrated aesthetic and functional improvement.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Modified Dorsal Split Preservation Hybrid Rhinoplasty for Cartilaginous Pushdown and Full Letdown Applications: A PROM-Based Review of 100 Consecutive Cases

Robotti¹,

Cottone

Leone³

2023

Facial Plast Surg

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“…4,9 The spare roof technique and the Ishida technique address only the nasal dorsum, in a superficial way, preserving the upper lateral cartilages (surface or dorsal modulation technique). [1][2][3][4]6,7 Thus, the spare roof technique is conceptually different from traditional preservation techniques and is supported by the anatomical concept of the spacial geometry, and the relation between the E-point and the beginning of the nasal hump 8 (Fig. 4).…”

Section: Discussionmentioning

confidence: 99%

Ferreira-Ishida Technique: Spare Roof Technique B. Step-by-Step Guide to Preserving the Bony Cap While Dehumping

Ferreira

Ishida

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Summary: For V-shaped nasal bones, the authors consider that ostectomy of the dorsal keystone area can be avoided, and this has led to the development of a new preservation technique: the spare roof technique B (or Ferreira-Ishida technique), where the bony cap is preserved. It includes six main steps, as follows. Step 1, draw on the surface of the skin the desired dorsal brow-tip aesthetic lines, the pyriform aperture, the rhinion, and the amount of triangular bone that has to be taken out to allow pushing-down the bony cap, and the transversal line in the beginning of the nasal hump. Step 2, release the upper lateral cartilages from the dorsal septum (“high septal strip”). Step 3, take out the amount of dorsal septum necessary to dehump. Step 4, perform the paramedian high parallel osteotomies exactly below the marked brow-tip dorsal aesthetic lines. Then, perform the second group of lower osteotomies, until the E-point, to achieve a triangular shape of bone in each side of the bony cap. Perform the ostectomy of the mentioned triangular areas. Release the lateral keystone area. Perform partial ultrasonic ostectomy endonasally, below the nasal bones, to promote the weakening of the transverse fracture line, in the sagittal plane just above the E-point. Push-down gently the rectangular bony cap with a Luc nasal forceps (19 cm) in a greenstick fashion. Perform lateral traditional osteotomies from high to low to high to narrow the bony bridge as much as is needed. Step 5, perform a regular L-shape Cottle septoplasty (if necessary). Step 6, suture the cartilaginous middle vault (upper lateral cartilages) to the dorsal aspect of the remaining septum.

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“…The structure of the internal nasal valve (INV). 12,13 In 1898, Jacques Joseph performed one of the first recorded reduction rhinoplasty cases by engaging a genuinely open approach with split hump reduction. The same year, Boston's J. L. Goodale performed an endonasal subdorsal septal excision, which involved pushing the dorsum down.…”

Section: Introductionmentioning

confidence: 99%

“…The same year, Boston's J. L. Goodale performed an endonasal subdorsal septal excision, which involved pushing the dorsum down. [10][11][12][13][14] Despite the variety of great minds at work in the field and some identified disadvantages of Joseph's method, such as the destructive nature of hump excision and the need to restore an open roof by medializing osteotomies, Joseph's approach to rhinoplasty became the preferred technique, evolving to introduce new techniques such as spreader grafts, camouflage grafts, and flaps. 14 Operating on a patient to remove a dorsal hump, Joseph described removing the subdorsal cartilage and lateral osteotomies to allow for the mobilization of the nasal vault.…”

Section: Introductionmentioning

confidence: 99%

Dorsal Preservation Rhinoplasty: A Literature Review

et al. 2021

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Acceptance of the preservation principle in rhinoplasty surgery has increased dramatically, and surgeons worldwide are now performing preservation rhinoplasty, leading to an expanding list of indications and techniques. Rhinoplasty surgeons are increasingly opting for rhinoplasty preservation because of its conservative approach and more predictable outcome. This review aims to evaluate the efficacy of dorsal preservation rhinoplasty, as well as the techniques, indications, surgical protocols, complications, and any practical challenges associated with this type of rhinoplasty. A number of medical databases, including Medline-PubMed, Embase, and Scopus, were searched. These searches were supplemented with a manual search using the keyword “preservation rhinoplasty” (PR) during the 1970 to May 2020 time span. The search strategy was limited to case reports, randomized clinical trials, and prospective studies of preservation dorsal rhinoplasty in journals published in English. A total of 150 articles that incorporated preservation dorsal rhinoplasty as a newer surgical technique were reviewed: 136 from PubMed, 17 experimental studies from Embase, 17 clinical studies from Scopus, and 8 studies identified by data extraction. Preservation rhinoplasty represents a paradigm shift in rhinoplasty philosophy. While techniques continue to improve, the philosophy remains the same: preserving and reshaping the existing nasal structures. Although not all patients benefit from and are satisfied with PR and some may only benefit from partial PR, preserving the anatomy allows for a more intuitive operation and natural results. For a more exhaustive review, readers are encouraged to turn their attention to dorsal preservation as a versatile and adaptable technique. Dorsal preservation avoids long-term issues with the middle vault and keystone area, and the patient benefits from total preservation, as the underlying structure can be reshaped without disruption.

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Treatment of the Nasal Hump with Preservation of the Cartilaginous Framework

Cited by 8 publications

References 0 publications

Modified Dorsal Split Preservation Hybrid Rhinoplasty for Cartilaginous Pushdown and Full Letdown Applications: A PROM-Based Review of 100 Consecutive Cases

Modified Dorsal Split Preservation Hybrid Rhinoplasty for Cartilaginous Pushdown and Full Letdown Applications: A PROM-Based Review of 100 Consecutive Cases

Ferreira-Ishida Technique: Spare Roof Technique B. Step-by-Step Guide to Preserving the Bony Cap While Dehumping

Dorsal Preservation Rhinoplasty: A Literature Review

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