The Pillars of the Nose-Crura Shortening for Over Projected Nose

Abstract

BACKGROUND: The over projected nose, commonly referred to as the "Pinocchio" nose is a significant challenge to the rhinoplasty surgeon. Firstly, we speak about a very large nose, and secondly, we speak about the correction of nasal cartilages (alar and triangular). Surgical correction of the over projected nose is the most difficult and least predictable component of rhinoplasty surgery.
 AIM: By performing rhinoseptoplasty we aimed to achieve an ideal landmarks position according to concepts of nasal projection as well as by making preoperative analyses to determine the ideal position for the nasal tip after having understood and defined the ideal position for the nasion.
 METHODS: We performed a retrospective study of patients who were admitted to ENT University Clinic, University Campus “St. Mother Theresa” Skopje, the Republic of Macedonia in the period 2011-2019. A total of 70 patients were enrolled in the study; 46 women (33%) and 24 men (33%). Operative technique rhinoseptoplasty was realised in 70 patients. All of the 70 (100%) patients underwent preoperative and postoperative evaluation during this period regularly to record the effects of various approaches on nasal projection, rotation, need for revision, and patient satisfaction.
 RESULTS: All patients used one or more of the preferred methods to treat over projection. Patients who had undergone 2 previous rhino/septoplasty procedures were excluded from the study, and hence, a total of 70 patients were evaluated. Full-transfixion incisions were made in all patients. From 2011 to 2019, in 72 cases, 1 or more of the preferred methods were used to treat over projection.
 CONCLUSION: The crural anatomy of the nasal tip relates to the size and shape of the lower lateral cartilages (LLC) and their relationship with the caudal septum and upper lateral cartilages (ULC). Modification of nasal tip rotation and projection should attempt to preserve or reconstruct major tip mechanisms.

Modern Concepts in Nasal Deprojection

“…Typical maneuvers used in deprojection have been described previously. [3][4][5][6][7][8][9][10][11] The surgical steps usually include wide undermining, release of the feet of the medial crura, component dorsum reduction, decreasing the tip while maintaining rotation, excising redundant mucosa, and eliminating dead space. These are effective in deprojecting the minimally or moderately overprojected nose (up to 3 mm), but fall short when addressing the severely overprojected nose, defined as nasal deprojection of greater than 3 mm, especially if the lower lateral cartilages are strong and inflexible.…”