Thomas J Willson1, Tyler Swiss2, Jose E Barrera3. 1. Department of Otolaryngology-Head and Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas. 2. Department of Health Education and Training, Tripler Army Medical Center, Honolulu, Hawaii. 3. Texas Facial Plastic Surgery and ENT, San Antonio4Uniformed Services University of the Health Sciences, Bethesda, Maryland5University of Texas Health Science Center, San Antonio.
Abstract
IMPORTANCE: Imparting surgical change to the nasal tip remains one of the most challenging aspects of rhinoplasty. The surgeon must assess the tip preoperatively and execute the necessary maneuvers to impart the desired change. OBJECTIVE: To assess nasal tip resistance to compression in a cadaveric model before and after specific rhinoplasty maneuvers using a novel method. DESIGN, SETTING, AND MATERIALS: Open rhinoplasty maneuvers were performed at an academic tertiary care center on 6 fresh-thawed cadaver heads. Assessment of tip support was performed with a motorized, computer-controlled test stand equipped with a digital load cell. Tip support was assessed by compression to a depth of 2.5 mm from contact both preoperatively and after each surgical maneuver. All force data were recorded in pound-force and converted to newtons (N) following analysis. MAIN OUTCOMES AND MEASURES: Nasal tip support, measured as resistance to compression, before and after various rhinoplasty maneuvers. RESULTS: Following the elevation of the skin-soft-tissue envelope with septoplasty, resistance to compression (1.82 N) was not significantly different from the preoperative assessment (1.60 N for all specimens). Tip support following placement of a caudal extension graft was significantly different from all other conditions (3.16 N; P < .01), showing support increased by more than 66% from preoperative assessment. Placement of columellar strut (1.28 N) did not show significant increase in tip support. Tip support was decreased slightly after placement of intradomal sutures, which was significant (1.22 N; P < .01). CONCLUSIONS AND RELEVANCE: This study demonstrates the use of materials testing equipment to assess and quantify change in tip support after several rhinoplasty maneuvers. Minor supporting maneuvers that rely on healing and scar do not significantly alter tip support in a cadaveric model. Caudal extension graft is an important maneuver imparting significant effect on nasal tip support. LEVEL OF EVIDENCE: NA.
IMPORTANCE: Imparting surgical change to the nasal tip remains one of the most challenging aspects of rhinoplasty. The surgeon must assess the tip preoperatively and execute the necessary maneuvers to impart the desired change. OBJECTIVE: To assess nasal tip resistance to compression in a cadaveric model before and after specific rhinoplasty maneuvers using a novel method. DESIGN, SETTING, AND MATERIALS: Open rhinoplasty maneuvers were performed at an academic tertiary care center on 6 fresh-thawed cadaver heads. Assessment of tip support was performed with a motorized, computer-controlled test stand equipped with a digital load cell. Tip support was assessed by compression to a depth of 2.5 mm from contact both preoperatively and after each surgical maneuver. All force data were recorded in pound-force and converted to newtons (N) following analysis. MAIN OUTCOMES AND MEASURES: Nasal tip support, measured as resistance to compression, before and after various rhinoplasty maneuvers. RESULTS: Following the elevation of the skin-soft-tissue envelope with septoplasty, resistance to compression (1.82 N) was not significantly different from the preoperative assessment (1.60 N for all specimens). Tip support following placement of a caudal extension graft was significantly different from all other conditions (3.16 N; P < .01), showing support increased by more than 66% from preoperative assessment. Placement of columellar strut (1.28 N) did not show significant increase in tip support. Tip support was decreased slightly after placement of intradomal sutures, which was significant (1.22 N; P < .01). CONCLUSIONS AND RELEVANCE: This study demonstrates the use of materials testing equipment to assess and quantify change in tip support after several rhinoplasty maneuvers. Minor supporting maneuvers that rely on healing and scar do not significantly alter tip support in a cadaveric model. Caudal extension graft is an important maneuver imparting significant effect on nasal tip support. LEVEL OF EVIDENCE: NA.