Effects of Release of Tip Supporting Fibrous Tissues for Short Nose Correction

Ko, Han Woong; Han, Seung Kyu; Lee, Byung Il; Kim, Woo Kyung

Abstract

A short nose is one that extends less than one third of the vertical height of the face or whose distance from nasion to tip-defining point is short. Lengthening short noses has been regarded as one of the most challenging and at times vexing tasks in secondary nasal surgery. For correction of short nose, nasal tip supporting tissues from alar cartilages are released and nasal tip is positioned and fixed again. There are five important nasal tip supporting tissues, fibrous connection between upper lateral cartilage and lower lateral cartilage, hinge region(fibrous connection between lateral border of lateral crus and pyriform aperture), interdormal attachment to anterior septal angle (fibrous tissue between anterior septal angle and middle crus), fibrous connection between septum and foot plate of medial crus and dermocartilaginous ligament. This study is to find out which one of the five nasal tip supporting tissues is the most important in short nose correction except dermocartilaginous ligament which has to be released during rhinoplasty. We dissected ten noses from ten fresh cadavers. Five were male and five were female with an average age of sixty three for all ten. We measured the distance between anterior septal angle and tip-defining point in every step of soft tissue dissection releasing the alar cartilage and mucosa, that are often released in short nose corrections and caudally pulling them to the direction of tip-defining point. First, distances were measured in resting and in pulling of alar cartilage. Further, changed distance were measured after releasing nasal tip supporting tissues beginning from the dissection of soft tissues between lateral crus and upper lateral cartilage to that of mucoperichondrium underneath upper lateral cartilage and septal mucoperichondrium. In each process, we found the average and standard variation, confirmed effects of those values to the lengthening of short noses. Dissecting upper lateral cartilage and lateral crus of alar cartilage was most effective in short nose correction. We also found it effective to release the hinge area and dissect the mucoperichondrium under upper lateral cartilage in lengthening the short noses.