OBJECTIVES: To quantify the changes in the strength of nasal tip support associated with various surgical modifications and to identify the procedures that best maintain or augment tip support. DESIGN: Case study in 2 phases. Phase 1 included 10 patients undergoing primary rhinoplasty, 5 undergoing secondary rhinoplasty, and 5 control patients. Fresh cadavers were used in phase 2. A purpose-built instrument (Beaty Tensegrometer; G. M. Tooling, Chamblee, Ga) was used to measure nasal tip support before and after surgical modifications. RESULTS: In the patients who underwent primary rhinoplasty, there was a 25% decrease in tip support when the ligamentous attachments between the lateral crura were divided. Reconstruction of these attachments increased tip support over baseline by 35%. With a columellar strut and ligament reconstruction, tip support was increased by 44%. In the secondary rhinoplasty group, reconstruction with the dynamic adjustable rotation tip-tensioning technique increased nasal tip support over baseline by 70%. In cadavers, intercartilaginous incisions and delivery of the lower lateral cartilages caused a loss of tip support, while raising the skin-soft tissue envelope with the open technique did not. Extensive resection of the lower lateral cartilages caused a loss of tip support. CONCLUSIONS: This study demonstrates that nasal tip support can be reliably quantified in a reproducible manner. Use of the open approach, reconstruction of the attachments between the lateral crura, conservative resection of the lower lateral cartilages, and the dynamic adjustable rotation tip-tensioning technique for secondary rhinoplasty best preserve nasal tip support.
OBJECTIVES: To quantify the changes in the strength of nasal tip support associated with various surgical modifications and to identify the procedures that best maintain or augment tip support. DESIGN: Case study in 2 phases. Phase 1 included 10 patients undergoing primary rhinoplasty, 5 undergoing secondary rhinoplasty, and 5 control patients. Fresh cadavers were used in phase 2. A purpose-built instrument (Beaty Tensegrometer; G. M. Tooling, Chamblee, Ga) was used to measure nasal tip support before and after surgical modifications. RESULTS: In the patients who underwent primary rhinoplasty, there was a 25% decrease in tip support when the ligamentous attachments between the lateral crura were divided. Reconstruction of these attachments increased tip support over baseline by 35%. With a columellar strut and ligament reconstruction, tip support was increased by 44%. In the secondary rhinoplasty group, reconstruction with the dynamic adjustable rotation tip-tensioning technique increased nasal tip support over baseline by 70%. In cadavers, intercartilaginous incisions and delivery of the lower lateral cartilages caused a loss of tip support, while raising the skin-soft tissue envelope with the open technique did not. Extensive resection of the lower lateral cartilages caused a loss of tip support. CONCLUSIONS: This study demonstrates that nasal tip support can be reliably quantified in a reproducible manner. Use of the open approach, reconstruction of the attachments between the lateral crura, conservative resection of the lower lateral cartilages, and the dynamic adjustable rotation tip-tensioning technique for secondary rhinoplasty best preserve nasal tip support.
Authors: David Shamouelian; Ryan P Leary; Cyrus T Manuel; Rani Harb; Dmitriy E Protsenko; Brian J F Wong Journal: Laryngoscope Date: 2014-08-11 Impact factor: 3.325