Surgery of the Nasal Tip

Quatela, Vito C.; Slupchynskyj, Oleh

doi:10.1055/s-0028-1082425

Cited by 20 publications

(12 citation statements)

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“…3,9,20 -22 These supporting elements of the nasal tip are commonly interrupted during the course of a routine rhinoplasty by maneuvers such as complete transfixion incisions, intercartilaginous incisions, reduction of the septal angle, and incising or excising cuts into the lower lateral cartilage. 8,22,23 For the supporting structure between the upper lateral cartilage and the lateral crus, Janeke and Wright have examined the macroscopic study using the cadaver, and reported that the cephalic rim of the lower lateral cartilage is firmly anchored to the caudal margin of the upper lateral cartilage with the fibrous tissue. 1 Kridel also called this supporting structure the fibrous attachment.…”

Section: Discussionmentioning

confidence: 99%

An Anatomic Study of Nasal Tip Supporting Structures

Han

Lee

Kim

et al. 2004

Annals of Plastic Surgery

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Successful rhinoplasty depends on nasal tip support and its influence on nasal tip projection. It is generally agreed that the components of nasal tip support include the attachment between the upper and lower lateral cartilages, the attachment between the lateral crus of the lower lateral cartilage and the pyriform aperture, the attachment between the paired domes of the lower lateral cartilages, and the medial crural attachment to the caudal septum. However, these structures are still not clearly determined, and there was no anatomic study of nasal tip supporting structures in Asia. The purpose of this study was to determine the nasal tip supporting structures and find out the differences in these structures between white and Asian people. Ten noses of fresh cadavers were investigated. Dissection was performed and the previously mentioned nasal tip supporting structures were observed and excised. Histologic examination was done with hematoxylin and eosin stain and Van Gieson elastin stain. Macroscopic study showed that there were dense fibrous tissue between the upper and lower lateral cartilages, dense fibrous tissue and sesamoid cartilages between the lateral crus and the pyriform aperture, loose connective tissue between the paired domes of lower lateral cartilages, and no identified specific tissue between the medial crus and the caudal septum. Microscopic investigation allowed a more detailed analysis of these structures. Between the upper and lower lateral cartilages, dense collagen fibers were running in one direction and anchoring firmly to each cartilage, which meets the histologic criteria of a ligament. Between the lateral crus and the pyriform aperture, there were intermingled collagen fibers and muscular fibers, which meets the histologic criteria of fibromuscular tissue. Between the paired domes of lower lateral cartilages, there were few fibers with abundant amorphous ground substances, which meets the histologic criteria of loose connective tissue. Based on our results, we recommend that the previously mentioned nasal tip supporting structures should be named intercartilaginous ligament, sesamoid fibromuscular tissue, and interdomal loose connective tissue, respectively. In addition, we consider that the loose connection between the domes of middle crura and the absence of an attachment of the medial crura to the caudal septum can be one of the reasons why the nasal tip of Asian people is broad and unprojected and the base is wide.

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Section: Discussionmentioning

confidence: 99%

An Anatomic Study of Nasal Tip Supporting Structures

Han

Lee

Kim

et al. 2004

Annals of Plastic Surgery

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“…Patients with bulbous noses and/or with divergent intermediate crura of the alar cartilage had larger fat pads [9]. Evaluations concerning anatomical structures in the nose have been more understandable with open rhinoplasty [1][2][3]. However, the pre-operative evaluation of the nose is based on the outer appearance of the nose and the surgeon's clinical experience.…”

Section: )mentioning

confidence: 98%

“…The choice of the technique is generally determined by the surgeon's educational background and his aptitude for the technique. Open rhinoplasty enables the surgeon to access to all anatomical structures more easily, specially enables him to perform maneuvers on the nasal tip easily and also provides a broader surgical exposure [1][2][3]. Various manipulations have to be made on the nasal tip especially when the patient has bulbous nose [4].…”

Section: Introductionmentioning

confidence: 99%

Ultrasonography for Rhinoplasty

Copçu¹

2005

CMIR

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Objective: To get the desired outcome and minimize the complications in rhinoplasty it is essential that the anatomy of the nose be precisely known and an appropriate surgical technique should be chosen for the existing problem in a given patient. Preoperative assessment in rhinoplasty is usually based on a physical examination and photographs of the patient. To date, there has been no objective diagnostic test for nose anomalies such as bulbous nasal tip.Methods: In this study we measured the interdomal distance and size of the interdomal fat pad using USG in a total of 40 rhinoplasty patients. Open rhinoplasty was performed in all patients. Also, interdomal fat pad was dissected and excised in all patients. The size of the specimens was determined and their histopathological diagnoses were made. All the cases were evaluated in the 6th month after the operations. Reviewing of the literature was performed.Results: Before the operation, six patients had been diagnosed as bulbous nasal tip clinically. In the patients with bulbous nose both interdomal distance and interdomal fat pad proportions were found to be larger than normal. In the cases in which tip refinement had been performed the interdomal distance was measured as zero.Conclusions: Joseph in 1931 used the "profilometer"; Webster et al. in 1977 used the projectometer in the evaluation of the nose. The evaluation of the anatomical structure of the nose has been the topic of many anthropometric studies and advanced and highly detailed studies with 3 dimensional facial plaster models; digitizer or laser surface scanners have appeared the literature. Tasman and Helbig used the ultrasonography in the evaluation of the nasal tip area. Evaluation of the interdomal space by using USG is quite simple, cheap and easily applicable. In addition, interdomal fat pad can be visualized and an objective criterion can be obtained for bulbous nose by measuring the interdomal distance on USG. Since the excision of interdomal fat pad could only be achieved by open rhinoplasty, and that tip refinement is required in order to correct the increased interdomal distance, pre-operative interdomal USG will guide the surgeon and provide objective criteria in determination of the operative technique in bulbous nose. This is the first study to show interdomal fat pad by a diagnostic test and it can be concluded that interdomal fat pad excision is necessary for the prevention of supratip.

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“…Resection of the caudal septum along with adequate amounts of vestibular mucosa will decrease the amount of visible columella. 4 Hemi-and full-transfixion incisions weaken the tip support and require suture reconstitution. The relationship between the medial crura and septum should be reestablished using either several horizontal mattress sutures or in TIG fashion.…”

Section: Nasal Base Stabilizationmentioning

confidence: 99%

Creating Elegance and Refinement at the Nasal Tip

Quatela

Kolstad

2012

Facial plast Surg

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Enhancing nasal tip definition requires a three-dimensional approach encompassing both form and function. Dome refinements achieved during surgery should be created with sufficient integrity to withstand postoperative healing forces. Stabilizing the nasal base is the first component of dome alterations and prevents loss of tip rotation and projection. Structural grafting can be used to enhance tip definition and at the same time adds support to the cartilaginous framework. Tip shield grafts camouflage dome asymmetries, establish the tip-defining point, and enhance the supratip break. Shield grafts can be placed in all skin types with appropriate contouring and camouflaging techniques.

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Surgery of the Nasal Tip

Cited by 20 publications

References 0 publications

An Anatomic Study of Nasal Tip Supporting Structures

An Anatomic Study of Nasal Tip Supporting Structures

Ultrasonography for Rhinoplasty

Creating Elegance and Refinement at the Nasal Tip

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