Anatomical considerations in the management of the hanging columella.

Abstract

To review the anatomy and dynamics of the hanging columella and to describe a technique to correct the causative anatomical deformity. Case series. A facial plastic surgery private practice in Highland Park, NJ. Consecutive sample of 10 patients (6 women and 4 men), aged from 27 to 52 years (mean age, 32 years). Through an external approach, the principal method of repair used in all cases involved transecting the medial and lateral crura at their angles to allow straightening of the medial crura. Comparative, standardized measurements of the alar-columellar complex in preoperative and postoperative photographs. Angle transection changed the spatial relation of the medial and lateral crura to each other resulting in straightening of the excessively curved medial crura. All patients had successful correction of the hanging columella. In our prospective study of 10 patients who required correction of hanging columellas, we have found the primary cause to be C-shaped curvature of the medial crura and their relation to the lateral crura. We observed long medial crura that were excessively curved, of normal width, and held in place by their continuity with the lateral crura. Dividing the alar cartilages at the angle of the medial and lateral crura released the connection of these structures allowing the medial crura to assume a straighter configuration. Tailoring of the feet of the medial crura and minimal septal shortening were occasionally used. Columellar struts, which were often used for other reasons, also provided additional medial crural straightening.