The Caudal Septum Columellar Strut Graft

Hidalgo, David A.; Doft, Melissa A.

doi:10.1097/prs.0000000000001457

Cited by 7 publications

(14 citation statements)

References 12 publications

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“…33 Rohrich et al 35 have described that the generalized use of columella strut grafts functions as a method of unifying the nasal tip and controlling the final tip projection. Hidalgo and Doft 36 have reported that columella strut grafts help correct midline columella deviations resulting from weak and distorted medial crura. Toriumi has reported that many Asian patients are in need of an increase in nasal tip projection while simultaneously conserving the nasal length.…”

Section: Discussionmentioning

confidence: 99%

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Correction of a Secondary Bilateral Cleft Lip Nasal Deformity in Adults Using Repositioning of Both Lower Lateral Cartilages and Nasal Tip Plasty Through an Open Bilateral Reverse-U Incision

Ryu

Lee

et al. 2021

Journal of Craniofacial Surgery

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Background: Correcting a secondary bilateral cleft lip nasal deformity is very complex with many challenges due to its complexity. This study presents the surgical results after correcting a secondary bilateral cleft lip nasal deformity using isolation and repositioning of the lower lateral cartilages, the columellar strut, and an onlay graft on the nasal tip. Method: Eighteen patients who had bilateral cleft lip nasal deformities and who had surgery performed between September 2013 and December 2019 were included in this study. The age of the patients ranged between 19 and 52 years. Open rhinoplasty with bilateral reverse-U incision was performed. The lower lateral cartilages were isolated and repositioned. Nasal tip support is provided using a columellar strut with a septal cartilage or Medpor strut. In the vertical component of the nasal tip, a conchal cartilage graft was used. The mean follow-up period was 2 years (ranging from 1 to 6 years). Results: Fourteen of the 18 patients underwent photogrammetric evaluation. After surgery, the projection of the nasal tip and angle increased, but nasal bridge length decreased. The columella-labial angle significantly increased by 10.1% after surgery which was statistically significant (P < 0.05). The angle between the nostril axes significantly decreased by 46.2% postoperatively and also reached statistical significance (P < 0.05), indicating that the displaced alar base and lower nostril sill improved and the major axis of the nostril changed more vertically oblique. All patients were pleased with their surgical results. Conclusion:The proposed technique was highly effective in correcting secondary bilateral cleft lip nasal deformities in adults.

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Section: Discussionmentioning

confidence: 99%

“…In particular, the columella strut affords a scaffold on which a variety of tip corrections can be used 32 . When used correctly, the columella strut affords enhanced structural integrity to the lower third of the nose, particularly the lower crura 33–39 . Overall, using an onlay cartilage graft is valuable for providing nasal tip in the lowered nasal tip.…”

mentioning

confidence: 99%

Correction of a Secondary Bilateral Cleft Lip Nasal Deformity in Adults Using Repositioning of Both Lower Lateral Cartilages and Nasal Tip Plasty Through an Open Bilateral Reverse-U Incision

Ryu

Lee

et al. 2021

Journal of Craniofacial Surgery

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“…Increased medial crural support contributes to establishing and maintaining the desired degree of tip projection and rotation. 39 Rohrich et al 41,42 have reported that the routine use of the columella strut graft can unify the nasal tip and help control final projection. Hidalgo and Doft 39 have proposed that strut grafts also help correct midline columella deviation resulting from weak and distorted medial crura.…”

Section: Discussionmentioning

confidence: 99%

Correction of Severe Secondary Cleft Lip Nasal Deformity

Cho

Park

Ryu

et al. 2021

Journal of Craniofacial Surgery

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Background: The lower lateral cartilages (LLCs) are key elements for alar and tip support. Repositioning of both LLCs is an effective procedure for correcting a laterally spreading dome of LLCs and drooping nasal tip in cleft lip nasal deformity (CLND). The alar contour graft has become an essential component of rhinoplasty for correcting the concave or collapsed and retracted alar. Herein, onlay cartilage graft was combined with nasal tip plasty to correct hypoplastic cleft lateral crus or alar rim retraction, and with columella strut to obtain better aesthetic outcomes in patients with severe CLND. Methods: Seven patients with severe secondary unilateral CLND, including hypoplastic cleft lateral crus or alar rim retraction, underwent rhinoplasty from October 2013 to April 2020. Both LLCs were isolated and repositioned approximated medially using tip suture technique combined with columella strut. A septal cartilage onlay graft was applied on the hypoplastic cleft lateral crus. Cartilage graft on the nasal tip was performed to further project and enhance the nasal tip. Photogrammetric evaluation of the operated patients and statistical analysis of the obtained data were performed. Results: The average age at operation was 23.5 (range: 17-36) years. The follow-up period was 6-36 (mean, 14.3) months. All patients were enrolled by photogrammetric evaluation. Height of the medial nostril and short axis of the nostril on the cleft side were increased with a statistical significance of P < 0.05, indicating that depressed ala on the cleft side, which is a feature of CLND, was corrected similar to that of the noncleft side. Conclusions: The alar contour cartilage graft, as an effective adjunctive technique, improves the alar margin, prevents the alar rim from collapsing, and provides supports to the cleft-side alar rim. It can be a prophylactic measure to prevent postoperative retraction in patients with weakened LLCs. Lower lateral cartilage repositioning, columellar strut, and nasal tip plasty are useful for correcting severe secondary unilateral CLND

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“…The structure aids in resisting compressive forces on the skin envelope and contractile forces for wound healing. 37 Increased nasal tip support contributes to creating and maintaining the desired degree of tip projection and rotation. Such a method is suitable for patients with saddle nose or short-nose deformities because ePTFE can provide a robust support to resist skin contracture, which is crucial for lengthening the nose and increasing tip projection by caudal rotation of the tip.…”

Section: Discussionmentioning

confidence: 99%

“…As previously mentioned, the biocompatibility associated with minimal chronic inflammation and foreign-body reaction surrounding ePTFE prevents its extrusion from the nasal tip. The structure aids in resisting compressive forces on the skin envelope and contractile forces for wound healing . Increased nasal tip support contributes to creating and maintaining the desired degree of tip projection and rotation.…”

Section: Discussionmentioning

confidence: 99%