Conservative Surgery of the Nasal Dorsum: Septal Pyramidal Adjustment and Repositioning

Abstract

The term SPAR (septum pyramidal adjustment and repositioning), aims to conserve the nasal dorsum without detachment of the upper lateral nasal cartilage of the nasal septum, based on the Cotte's principles, unlike classical rhinoplasty. The aim of the study is to describe surgical technique of SPAR with the surgical steps used to reviewing the literature on the surgical treatment of the nasal dorsum. This is a less invasive form of rhinoplasty, but no less effective, not being necessary additional techniques to nasal reconstruction, and preservation of essential nasal structures. It is an evolution of push down and the other conservative surgery, making a more modern technique and may be suitable for most types of cavities. More studies are needed, especially comparative, showing the following late sequelae, complications, and their long-term results.

State of the Evidence for Preservation Rhinoplasty: A Systematic Review

“…3,7,12,[21][22][23][24][25][26][27][28][40][41][42] The remaining references include subjective or photographic evaluation of cosmetic and/or functional outcomes as well as analysis of complication rate, postoperative dorsal hump recurrence, and revision rates. 1,2,8,10,11,[14][15][16][17]20,33,35,37,39,[45][46][47][48] Overall, the DPR techniques are reported to have a complication rate ranging from 0 to 25.80% with the majority of reported complications being minor. 1,9,10,12,13,[16][17][18][23][24][25][26][27]30,34,35,3...…”

“…1,2,7,13,[15][16][17][18][20][21][22]29,30,34,35,41,42,[44][45][46][47] Postoperative dorsal hump revision rates were reported by 25 studies and ranged from 0 to 15%. 1,2,7,[9][10][11]13,15,17,18,[20][21][22][23][24][25][26][27][28]35,[40][41][42][44][45][46][47][48] Facial Plastic Surgery Vol. 39 No.…”

Partial Release of Pyriform Ligament to Prevent Deformities on Keystone Area

“…8). 3,4,6,13,16,[34][35][36][37][38][39][40][41][42] In the present research, the author described new approaches for releasing the pyriform ligaments in patients who received either push-down and let-down approach. The first approach which is demonstrated by Figure 2A has been already performed by the author of the present paper in which the push-down technique without osteotomy was described.…”

Osteotomy Techniques in Preservation Rhinoplasty with an Analysis of a Radix–Skull Base Computed Tomography Series

“…24 The edge of the osteotome may be used to create this line, gradually deepening it and creating a controlled fracture (transcutaneous MESO at the lateral wall). Alternatively, an incision at the inner end of both brows to introduce the osteotome can be used to hide the incision, as shown by Dewes et al 25 Another option is through a single central incision at the radix, allowing Osteotomy Techniques in Preservation Rhinoplasty Neves et al…”