Anatomical study of the medial crura and the effect on nasal tip projection in open rhinoplasty.

Abstract:

BACKGROUND:Common variations in morphology of the medial crura have been described. The authors' observation is that changes in nasal tip projection depend on the shape and strength of the medial crura. The authors investigated how differences in medial crura shape affect tip projection after surgical intervention. METHODS:Seventeen cadaver heads were dissected with an open rhinoplasty approach. Nasal tip projection and columellar length and width were measured. Medial crura shape was noted and classified. Anthropometric measurements were made preoperatively and after each of the following procedures: (1) elevation of skin envelope and closure of the columellar incision, (2) interdomal and medial crural sutures, and (3) placement and fixation of a floating columellar strut. RESULTS:Three anatomical variations of the medial crura were noted: type 1, asymmetric parallel (n = 7); type 2, flared symmetric (n = 5); and type 3, straight symmetric (n = 5). A significant difference in tip projection after elevation of the skin envelope and closure was discovered between types 1 and 3 (p = 0.004). Type 2 medial crura were found to have a mean reduction of 1.0 mm. Suture techniques resulted in return to baseline tip projection for types 1 and 2. Columellar strut placement increased tip projection in all types. CONCLUSIONS:Changes in tip projection after an open rhinoplasty depend on the shape of the medial crura. Straight symmetric (type 3) cartilages can maintain tip projection without any additional intervention during an open rhinoplasty. Asymmetric parallel (type 1) or flared symmetric (type 2) variants will require interdomal and medial crural sutures to maintain baseline tip projection.

journal_name

Plast Reconstr Surg

authors

Patel KB,Mendonca DA,Skolnick G,Woo AS

doi

10.1097/PRS.0b013e3182a0137a

subject

Has Abstract

pub_date

2013-10-01 00:00:00

pages

787-793

issue

4

eissn

0032-1052

issn

1529-4242

pii

00006534-201310000-00010

journal_volume

132

pub_type

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