Partial Release of Pyriform Ligament to Prevent Deformities on Keystone Area

Abstract

The dorsal hump deformity is common among Western countries based on the nasal structure of Caucasians. Dorsal preservation techniques which leads keeping the keystone area intact can bring positive outcomes such as obtaining aesthetic dorsal lines and better functional results. The positions of soft tissue in the face are supported with a combination of static and dynamic ansatomy. The static support is maintained by ligaments and their associations. Among the ligaments, the pyriform ligament takes a particular role in terms of supporting the alar base, lower lateral cartilages, and nasal tip. In the present research, it was aimed to investigate the beneficial effects of releasing pyriform ligament partially in patients who received dorsal preservation rhinoplasty. The data of the patients who had dorsal rhinoplasty operations for hump deformity were screened retrospectively. A total of 139 patients were included according to inclusion and exclusion criteria and their records were assessed (112 females and 27 males). Twelve months after surgery, the median Rhinoplasty Outcome Evaluation score increased from 52.5 to 91.5 points (P<0.001). Patient satisfaction was excellent in 86.95% of the included cases according to the Rhinoplasty Outcome Evaluation score. The present study shows a new, suitable, and easy approach for releasing the pyriform ligaments partially and as well as also were left intact. It is suggested that manipulation of the pyriform ligament during push-down and let-down procedures seems to be essential for obtaining a better nasal tip as well as narrowing the nose base and getting better functional outcomes.