Rhinoplasty Fundamentals

Introduction Nasal airway obstruction (NAO) is defined as the sensation of insufficient airflow or difficulty breathing through the nose. A common problem in otolaryngology, NAO affects approximately 20 million Americans with a significant impact on quality of life (QOL).1-4 NAO can be caused by infectious, allergic, vasomotor, or structural abnormalities, with etiology impacting the optimal… [Read More]

Plumping Grafts Plumping grafts may he used to open up an acute nasolabial angle, improve a retracted columella, and support a deficient nasal base. Dissect a midcolumellar precise pocket to just above the nasal spine. Place multiple small pieces of cartilage (I mm to 2 mm), harvested from the septum or ear, in the pocket…. [Read More]

Alar Base Resection Follow the accompanying figures and text to perform alar base resections (1,2). The site of incisions and the amount, degree, and geometry of alar reductions depend on a host of anatomic variations predetermined before and during surgery. Although the surgeon’s aesthetic judgment will ultimately determine the site and degree of resection, a… [Read More]

Surgery of the Nasal Tip EXERCISES (Appendix F) Placement of Columellar Strut The placement of a rectangular cartilage strut between the medial crura can improve tip support and augment tip projection. A columellar strut also can be used to correct buckled medial or intermediate crura or to increase columellar show. The strut may be placed… [Read More]

Spreader Grafts Spreader grafts may be placed endonasally or via the external rhinoplasty approach. If en donasal placement of spreader grafts is done in this dissection, undertake this before hump reduction and osteotomies. Through a small (5-mm) mucosal incision near the anterior septa] angle, develop a pre cise subperichondrial pocket along the length of the… [Read More]

Techniques in surgery can be seen as tools to help achieve a specific task. A tennis player’s tools may be seen as his forehand and backhand, his net game and serve, and so on. These tools on their own are not necessarily enough, but rather the right combination of strokes or tools must be achieved… [Read More]

Medial Osteotomies To perform medial osteotomies, insert the osteotome at the junction between the nasal bone and septum. With the two-tap technique, advance the cutting edge cephalad and fade laterally as the frontal bone is reached (Fig. 1). Control the sharp leading edge of the chisel, as it moves under the skin, with the forefinger… [Read More]

Incisions and Approaches Incisions are methods of gaining access to the bony and cartilaginous structures of the nose and include trans-cartilaginous, inter-cartilaginous, marginal, and trans-columellar incisions. Approaches provide surgical exposure of the nasal structures including the nasal tip and include cartilage-splitting (trans-cartilaginous incision), retrograde (inter-cartilaginous incision with retrograde dissection), delivery approach (inter-cartilaginous, marginal incisions), and… [Read More]