Advertisement

Aesthetic Plastic Surgery

, Volume 43, Issue 5, pp 1257–1268 | Cite as

A Modified Dorsal Split Preservation Technique for Nasal Humps with Minor Bony Component: A Preliminary Report

  • Enrico Robotti
  • Nkhensani Yvonne Chauke-Malinga
  • Francesco Leone
Innovative Techniques Rhinoplasty
  • 204 Downloads

Abstract

Background

In scenarios of a dorsal hump with minor bony cap, ideal esthetic dorsal lines can be preserved and refined by component separation of the upper lateral cartilages from the septal T, resection of a septal strip and ethmoid bone wedge, adjustment of width and symmetry and final re-suture of the cartilaginous dorsum after pushdown, improving width and symmetry. The associated bony cap is managed by osteoplasty only with or without narrowing osteotomies, and septal deviations can be concomitantly corrected.

Objectives

A novel technique of modified dorsal cartilaginous pushdown after component separation is described in detail. This method illustrates the importance of preserving the integrity of the septal T anatomy and the elastic keystone junction.

Methods

A preliminary series of 41 consecutive patients with follow-up up to 1 year, with a mean of 6 months, is reviewed.

Results

All patients presented favorable outcomes with a natural looking dorsum. A learning curve led to progressive improvements by suture fixation of the septal T, finesse adjustment of dorsal width and symmetry, fine-tuning of deviation and gradual extension of the technique to include cases that required osteotomies without transverse element and those with any degree of septal manipulation.

Conclusion

Disrupting the keystone area is fraught with potential complications which often lead to secondary revision. A modified dorsal preservation technique with pushdown limited to the septal T component of the cartilaginous dorsum combines the popular component separation concept with the preservation of the delicate anatomy of the mid-vault.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Keywords

Rhinoplasty Keystone Nasal dorsum Preservation rhinoplasty Pushdown Septal T 

Notes

Acknowledgements

The senior author acknowledges and thanks RK. Daniel, MD, for his support in the editing of this manuscript and his significant further contributions regarding pertaining anatomy and related nomenclature. We thank Leonardo Ioppolo, MD, for the 3D illustrations of the technique, shown within the accompanying video. We thank the patients whose photographs appear under study for their kind consent.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed were in accordance and with the 1964 Helsinki Declaration and its later approval amendments or comparable ethical standards. No study regarding ethical approval was performed.

Informed Consent

Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

Supplementary material

Supplementary material 1 (WMV 43958 kb)

Supplementary material 2 (WMV 60127 kb)

Supplementary material 3 (WMV 50514 kb)

References

  1. 1.
    Saban Y, Daniel RK, Polselli R, Trapasso M, Palhazi P (2018) dorsal preservation: the push down technique reassessed. Aesthet Surg J 38(2):117–131CrossRefPubMedGoogle Scholar
  2. 2.
    Cerkes N (2013) Concurrent elevation of the upper lateral cartilage perichondrium and nasal bone periosteum for management of dorsum: the perichondro-periosteal flap. Aesthet Surg J 33(6):899–914CrossRefPubMedGoogle Scholar
  3. 3.
    Rohrich RJ, Muzaffar AR, Janis JE (2004) Component dorsal hump reduction: the importance of maintaining dorsal aesthetic lines in rhinoplasty. Plast Reconstr Surg 114(5):1298–1308CrossRefPubMedGoogle Scholar
  4. 4.
    Daniel RK, Palhazi P (eds) (2018) Rhinoplasty: an anatomical and clinical atlas. Springer, Berlin, pp 122–123Google Scholar
  5. 5.
    Gerbault O, Daniel RK, Kosins AM (2016) The role of piezoelectric instrumentation in rhinoplasty surgery. Aesthet Surg J 36(1):21–34CrossRefPubMedGoogle Scholar
  6. 6.
    Palhazi P, Daniel RK, Kosins AM (2015) The osseocartilaginous vault of the nose: anatomy and surgical observations. Aesthet Surg J 35(3):242–251CrossRefPubMedGoogle Scholar
  7. 7.
    Robotti E, Choc IS, Jaber O (2017) Use of the “Septal T” as a spacer and conformer for a properly contoured nasal tip in rhinoplasty. Aesthet Surg J 37(1):122–127CrossRefPubMedGoogle Scholar
  8. 8.
    Gubisch W (2006) Twenty-five years experience with extracorporeal septoplasty. Facial Plast Surg 22(4):230–239CrossRefPubMedGoogle Scholar
  9. 9.
    Çakir B, Doğan T, Öreroğlu AR, Daniel RK (2013) Rhinoplasty: surface aesthetics and surgical techniques. Aesthet Surg J 33(3):363–375CrossRefPubMedGoogle Scholar
  10. 10.
    Afrooz PN, Rohrich RJ (2018) The keystone: consistency in restoring the aesthetic dorsum in rhinoplasty. Plast Reconstr Surg 141(2):355–363CrossRefPubMedGoogle Scholar
  11. 11.
    Robotti E (2018) Shaping the nasal dorsum. HNO 66(2):92–102 (Review) CrossRefPubMedGoogle Scholar
  12. 12.
    Daniel RK (2018) The preservation rhinoplasty: a new rhinoplasty revolution. Aesthet Surg J 38(2):228–229CrossRefPubMedGoogle Scholar
  13. 13.
    Lothrop OA (1914) An operation for correcting the aquiline nasal deformity; the use of new instrument; report of a case. Boston Med Surg J 170:835–837CrossRefGoogle Scholar
  14. 14.
    Cottle MH, Loring RM (1946) Corrective surgery of the external nasal pyramid and the nasal septum for restoration of normal physiology. Ill Med J 90:119–135PubMedGoogle Scholar
  15. 15.
    Huizing EH (1976) Push-down of the external nasal pyramid by resection of wedges. Rhinology 13:185–190Google Scholar
  16. 16.
    Pinto RM (1997) On the “let-down” procedure in septorhinoplasty. Rhinology 35(4):178–180PubMedGoogle Scholar
  17. 17.
    Gola R (2003) Functional and esthetic rhinoplasty. Aesthet Plast Surg 27(5):390–396CrossRefGoogle Scholar
  18. 18.
    Saban Y, Braccini F, Polselli R (2005) Morphodynamic anatomy of the nose. In: Saban Y, Braccini F, Polselli R, Micheli-Pellegrini V (eds) Rhinoplasties, vol 2002. The monographs of CCA group. n°32, Paris, pp 25–32Google Scholar
  19. 19.
    Saban Y, Braccini F, Polselli R (2006) Morphodynamic anatomy of rhinoplasty. Interest of conservative rhinoplasty. Rev Laryngol Otol Rhinol (Bord) 127(1–2):15–22Google Scholar
  20. 20.
    Skoog T (1966) A method of hump reduction in rhinoplasty: a technique for preservation of the nasal roof. Arch Otolaryngol 83:283–287CrossRefPubMedGoogle Scholar
  21. 21.
    Hall JA, Peters MD, Hilger PA (2004) Modification of the Skoog dorsal reduction for preservation of the middle nasal vault. Arch Facial Plast Surg 6(2):105–110CrossRefPubMedGoogle Scholar
  22. 22.
    Sabeti F, Tehrani AN (2002) A new technique for reconstruction of the nasal dorsum: underlay autografting. Arch Facial Plast Surg 4:141–148CrossRefPubMedGoogle Scholar
  23. 23.
    Constantinidis J, Fyrmpas G (2016) Reinserting the hump in primary rhinoplasty: the gain is three-fold. Plast Reconstr Surg Glob Open 4(10):e1021CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Daniel RK (1989) Rhinoplasty: the retractable roof. Plast Reconstr Surg. 83(6):976–983 (discussion 984) CrossRefPubMedGoogle Scholar
  25. 25.
    Ishida J, Ishida LC, Ishida LH, Ferreira MC, Vieira JC (1999) Treatment of the nasal hump with preservation of the cartilaginous framework. Plast Reconstr Surg 103(6):1729–1733 (discussion 1734–1735) CrossRefPubMedGoogle Scholar
  26. 26.
    Ferreira MG, Monteiro D, Reis C, Almeida e Sousa C (2016) Spare roof technique: a middle third new technique. Facial Plast Surg 32(1):111–116CrossRefPubMedGoogle Scholar
  27. 27.
    Santos M, Rego ÂR, Coutinho M, Sousa CAE, Ferreira MG (2018) Spare roof technique in reduction rhinoplasty: prospective study of the first one hundred patients. Laryngoscope 10:4Google Scholar
  28. 28.
    Gerbault O, Rollin KD, Palharzi P, Kosins A (2018) Reassessing surgical management of the bony vault in rhinoplasty. Aesthet Surg J 38(6):590–602CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  1. 1.BergamoItaly
  2. 2.JohannesburgSouth Africa
  3. 3.BergamoItaly

Personalised recommendations