Septocolumellar Suture Research Articles

Standardizing Septocolumellar Sutures: A New Practical Classification.

The septocolumellar sutures are very helpful to obtain planned rotation and projection. The goal of this study is to revitalize the septocolumellar techniques described before and present an easy new classification for these sutures, and to present their multiple uses on the same patient as a new option for surgeons. Eighty patients were involved in this retrospective study. All the patients were females except one. A detailed preoperative preparation was performed on all patients by following the principles of precision profileplasty. In this study, five main types of septocolumellar sutures were used. Type 4 septocolumellar suture was used in 39 cases, type 3 in 33, type 2 in 22, type 1 in 5, and type 5 in 2 cases. In 21 cases, more than one suture was used. In conclusion, the new practical classification presented in this study gives the surgeon powerful tools to reshape the tip during surgery.

Controlling Nasal Tip Projection and Rotation with New Composite Septocolumellar Flap Approaches.

Rhinoplasty is one of the most common and challenging surgeries in the field of aesthetic surgery. For obtaining an aesthetically pleasing nose, it is extremely important to control nasal tip projection and rotation as much as possible. Since the last decade, septocolumellar suture techniques have been most frequently used for modifying and controlling nasal tip rotation and projection and for obtaining a better columellar-labial angle during rhinoplasty. In the present study, the author has described 10 different approaches using composite septocolumellar flaps with the aim of obtaining better outcomes, such as the control of nasal tip projection and rotation, in addition to obtaining better tip refinement. The records of 68 patients were included in the present study based on the inclusion and exclusion criteria. Ten composite septocolumellar flap approaches were followed by the same surgeon. The initial median Rhinoplasty Outcome Evaluation score was 60.5 points; the score increased to 92.5 points at 12 months after the surgery (p < 0.001). Satisfaction was excellent in 87.5 percent of the patients. The patients were also evaluated in terms of functionality. Their patency scores increased from 6.0 to 9.0 (out of 10) after a 12-month follow-up (p = 0.001). The technique has the following advantages: control of nasal tip projection and rotation, fixation of mild deviations, and shortening of the nose with better aesthetic and functional outcomes. Furthermore, because the septocolumellar region is completely protected and remains solid, a dynamic nasal tip is obtained. Surgeons will be able to choose the most suitable approach when a composite septocolumellar flap is needed. Therapeutic, IV.

Septocolumellar Suture Technique for Correction of Septal Caudal Dislocation

Objective: To describe this technique for treatment of caudal septal dislocation and to evaluate the effectiveness of this technique in terms of correction of cosmetic deformity and relief of nasal obstruction.Methods: This was a descriptive case series study performed at ENT department of Services Institute of Medical Sciences (SIMS), Services Hospital, Jail Road, Lahore. 30 Cases of mild to moderate degree of septal caudal dislocation were selected and operated. The septum was fixed by sutures to the anterior nasal spine. Columellar pocket was made and septum was sutured in the pocket by two sutures at upper and lower levels to increase the stability of corrected septum.Results: We performed this suturing technique on 30 septoplasty cases during 3 years from Jan-2016 to Jan-2019. Among them 12 (40%) were male and 18 (60%) were female. Total follow up period ranged between 3 to 6 months. Anterior rhinoscopy showed no persistence of deviation or dislocation in 25 patients. 5 cases had mild deviation of septum on non-operated side.Conclusion: Two level septocolomellar suture technique is very effective, easy to learn &amp; perform and shows long term reliability in correction of caudal septal dislocation. This is effective in improving cosmesis and nasal air flow.

Comparing the Effects of Tongue-In-Groove and Septocolumellar Suture With Short and Floating Columellar Strut of Open Rhinoplasty on Nasal Tip Rotation and Projection

In rhinoplasty, it is important to maintain the desired tip projection and rotation. The aim of the present study was to compare the tongue-in-groove (TIG) method and the septocolumellar suture method with short and floating columellar strut methods over a six-month follow-up period. A total of 69 patients were evaluated. The TIG method was used on 39 patients (group 1, TIG group), and the remaining 30 patients received septocolumellar suture supported with short and floating columellar strut (group 2, suture+graft group). Standardized right profile images were taken preoperatively and 6 months after the operations. Goode's method and nasofacial angle were used to evaluate nasal tip projection, and the nasolabial angle was measured to evaluate tip rotation. The outcomes of the 2 surgical approaches were compared, and P values lower than 0.05 were considered significant. Although nasal tip rotation in the postoperative sixth month was higher than that in the preoperative period in both groups (TIG: 96.8° vs 108.2° and suture+graft: 100.8° vs 104.2°, respectively), this change was significant only in the TIG group (P<.001). Goode's ratio increased significantly in both groups compared with the postoperative period (TIG: 0.62 vs 0.57 and suture+graft: 0.62 vs 0.58; P<.001 and .047, respectively). On the other hand, nasofacial angle decreased significantly in both groups compared with the postoperative period (TIG: 147.8° vs 144.0° and suture+graft: 149.1° vs 146.3°; P<.001). As per the results of the present study, both studied methods can be safely used in nasal tip surgery. Compared with the septocolumellar suture+columellar strut method, the TIG method resulted in a higher rotation increase. Both methods led to significant increases in projection, and these increases did not differ between the groups.

Two-level septocolumellar suture technique in closed septorhinoplasty

Two-level septocolumellar suture technique in closed septorhinoplasty

The Effect of the Short and Floating Columellar Strut Graft and Septocolumellar Suture on Nasal Tip Projection and Rotation in Primary Open Approach Rhinoplasty.

The maintenance of desired tip projection and rotation is an important goal in rhinoplasty. In this study, the effects of the columellar strut graft and septocolumellar sutures were evaluated in a follow-up period of 1year. In half of 44 patients, nasal tip was constructed with basic tip maneuvers and two septocolumellar sutures (Group-1, Suture Group), whereas in the remaining 22 patients, a columellar strut graft was added for tip support (Group-2, Suture+Graft Group). Standardized right profile images were taken preoperatively, 1month postoperatively and 1year postoperatively. Nasal tip projection was evaluated using Goode's method. For the evaluation of tip rotation, the nasolabial angle was measured. The results were statistically compared, and a p value lower than 0.05 was considered as significant. Between the postoperative first month to first year, the loss of tip projection was 3.8% in Group-1 and 3.5% in Group-2 which was statistically insignificant (p value 0.942). The loss of tip rotation was found as 4.6° (4.1%) in Group-1 and 4.6° (4.0%) in Group-2 which was also statistically insignificant (p value 0.979). Considering the results of the study, in most of the primary cases, two septocolumellar sutures in conjunction with basic tip maneuvers are sufficient for positioning and stabilizing of the nasal tip, and a short and floating columellar strut graft does not have any affect in maintenance of the desired nasal tip rotation and projection. 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 A3 online Instructions to Authors. www.springer.com/00266 .

Tip-Oriented Closed Rhinoplasty Built on Septocolumellar Suture and a New Caudal Septal Graft Technique.

A beautiful and appealing nose receives the greatest contribution from the nasal tip subunit, which should be regarded as the primary center of attention during a rhinoplasty procedure. In achieving the desired shape and position of the nasal tip during closed rhinoplasty, the septocolumellar suture functions as the major determinant together with the caudal portion of the septal cartilage, which has a significant influence on the versatility of the septocolumellar suture. The purpose of this study was to present the analysis of the indications, the technical steps, and the advantages of caudal septal graft and septocolumellar suture utilization in closed rhinoplasty. The septocolumellar suture with or without the caudal septal graft combination procedure has been performed in 2286 patients via a closed rhinoplasty approach. Intraoperatively, the septal cartilage at hand was thoroughly evaluated and one of the 5 types of caudal septal grafts was used when necessary. After the establishment of a strong and straight septal cartilage with sufficient height and length, 4 different septocolumellar sutures in a specific order were used to modify the relationship between the lower lateral cartilages and the nasal septum. Of the 2286 cases, 1837 (80.3%) were primary and 449 (19.7%) secondary rhinoplasties, which have been followed up for 9 to 48 months. The caudal septal graft was combined to the septocolumellar suture in 621 (27.1%) patients. Of the caudal septal grafts, 69.7% were used for primary rhinoplasty cases, and 30.3% for secondary rhinoplasties. At the 18th month postoperatively, tip projection was found to be satisfactory for 98% of the patients. The septocolumellar suture combined with caudal septal graft in closed rhinoplasty substantially facilitates the achievement of a cosmetically and functionally pleasing end result, bringing the solution for a wide array of problems such as short nose, supratip deformity, nasolabial angle change, or columellar bowing. Nevertheless, the technique has a steep learning curve; therefore, a meticulous preoperative evaluation should be exerted, a precise surgical planning should be prosecuted, and an excessive reduction of the nasal tip or exaggerated columellar retraction should be avoided.

Two-level septocolumellar suture technique for correction of septal caudal dislocation

IntroductionCaudal septal dislocation is a respiratory and cosmetic problem. The correction of caudal septal dislocation is a challenging issue. Although different modalities have been described for the treatment, it is still controversial. ObjectivesThis study aims to describe a two-level suture technique which can be used to correct and stabilize the septum in the columellar pocket. MethodsThe caudal septum was fixed to the nasal spine with suturing, and an anterior columellar pocket was formed. Two septocolumellar sutures including superior and inferior were performed to correct the dislocated caudal septum and to increase the stability of caudal septum in the columellar pocket. ResultsAnterior rhinoscopy showed no recurrent deviation or dislocation in our patients. ConclusionOur suture technique is an effective and easy-to-use method to correct the caudal septal dislocation. It can also be used to increase the stability of corrected septum by other techniques. A two-level suture technique increases the success of correction and reduces the risk of postoperative septal caudal luxation, stabilizing the superior portion of the caudal septum, in particular. Therefore, it would reduce the rate of redo surgeries.

Septocolumellar Suture in Closed Rhinoplasty

Septocolumellar Suture in Closed Rhinoplasty

Septocolumellar Suture in Closed Rhinoplasty

Several surgeons advise a variety of tip sutures and describe their own techniques in open approach. Septocolumellar suture is one of them and can be described as a loop suture between the medial crura and caudal septum. Although some of the articles mention that it can be applied in closed rhinoplasty, there is no description of the technical details. This paper presents indications, technical steps, and advantages of the septocolumellar suture in closed rhinoplasty. After completing the classic sequence of the endonasal extramucous technique, the medial crural cartilages are dissected from the overlying skin at the midcolumellar level, keeping the distal fibrous attachments between the anterior columellar skin and these cartilages intact. A 5/0 or 4/0 Prolene (Ethicon Ltd, UK) with a round needle is passed, penetrating both the medial crura and then the caudal septum. Depending on the penetration level of this suture, the tip projection can be increased or decreased, the tip can be rotated, and columellar show can be corrected. This suture also makes the medial crura of the alar cartilages and septum rigidly fixed together, thus providing stability. Depending on the experience gained in 433 primary and 62 secondary rhinoplasty cases since 2000, it can be claimed that this technique, presenting an alternative to the open approach in many cases and expanding the borders of closed approach, allows one to manipulate the tip and columella easily with closed rhinoplasty and provides a significant decrease in the suboptimal results and number of complications.

Rhinoplasty tip ptosis: etiology and prevention.

AbstractCommonly, 12‐18 months must elapse before the final postoperative result following rhinoplasty may be judged. Unless actively compensated for during surgery, an inconstant degree of nasal tip ptosis (“settling”) may lead to displeasing nasal profile characteristics. Supra‐tip rounding accentuates tip ptosis, creating the undesirable “pollybeak” deformity. Generally, these two complications of rhinoplasty are predictable and preventable, providing that their various etiologies are clearly understood.Nasal tip ptosis in the postoperative healing period occurs if false projection of the tip confuses the surgeon. Operative tip swelling (infiltration anesthesia and edema) along with malpositioned columellar “bunching” sutures and “orthopedic” septocolumellar sutures create spurious tip projection. Loss of normal tip support occurs when incisions interrupt the attachment of the lower lateral cartilages to the upper lateral cartilages as well as the “wrap‐around” relationship of the feet of the medial crura to the caudal cartilaginous septum. Complete transfixion incisions should be avoided when possible. Cartilaginous or bony shoring struts increase tip support. Modeling of the lower lateral cartilage should not include over‐generous removal of the lateral crura, thus further weakening tip support.Unfavorable healing factors contributing to tip ptosis include linear contraction of the transfixion incision scar, the natural downward torque influence of the lower lateral cartilages, and detrimental synergistic activity of specific muscles of facial expression.Tip ptosis may accentuate the undesirable formation of supra‐tip prominence, thus unmasking the eventual stigma of “pollybeak” deformity. Supra‐tip prominence may develop as the result of:1. Inadequate lowering of cartilaginous dorsal hump.2. Inadequate lowering of upper lateral cartilages.3. Insufficient nasal skin undermining.4. Failure to excise adequately redundant mucous membrane projecting above the newly‐established profile line.5. Inadequate tip splinting.Preventive operative maneuvers can reduce the incidence of displeasing profile relationships, leading to a natural and harmonious postoperative rhinoplasty appearance.

Evaluation of the orthopedic septo-columellar suture in rhinoplasty.

Evaluation of the orthopedic septo-columellar suture in rhinoplasty.

Postoperative dropping of the nasal tip after rhinoplasty.

Results after rhinoplasty are said to be variable, unpredictable, and uncontrollable; and the portion of the newly fashioned nose most frequently involved is the nasal tip. Secondary dropping of the nasal tip ruins more results in rhinoplasty than any other feature of the operation. The result of rhinoplasty is usually satisfactory at the end of the operation, but four to six weeks later we unfortunately observe that the tip occasionally droops. The nose becomes longer; the cartilaginous dorsum appears too high, and the component parts of the alar cartilages in the tip change in relation to each other. The result is a rounded, unattractive, and unsatisfactory nose. The causes of secondary dropping of the nasal tip are said to be (1) scar contractures at the septocolumellar suture line, and (2) weight of the lobule. I have tried to stress a third cause: the pull-down action of the depressor septi nasi

Role of depressor septi nasi muscle in rhinoplasty.

Secondary dropping of the nasal tip ruins more results in rhinoplasty than any other feature of the operation. Joseph made the observation that there are two results after rhinoplasty: the temporary, and the permanent result. At the end of the operation, the esthetic result is usually satisfactory, assuming that the surgeon has reasonable artistic and surgical skill. Unfortunately, the passing of time frequently brings changes in the contour of the nose, the distressing change being a downward sagging of the nasal tip. This results in a rounded pendulous undesirable tip, a high supratip profile line, and a nose that is too long. There are two causes that bring about these undesirable changes: (1) linear scar contractures along the septocolumellar suture line, and (2) the downward pull of the depressor septi nasi and orbicularis oris muscles of the lip. In two previous articles, I described the use of Stainless-Steel septocolumellar sutures

Use of stainless-steel sutures in rhinoplasty.

THE USE of stainless-steel septocolumellar sutures in cosmetic rhinoplasty is effective and practical in the prevention of secondary dropping of the nasal tip. The surgical technique commonly used in rhinoplasty has advanced to such an extent that one may be justified in expecting a highly satisfactory improvement in the appearance of the nose at the end of the operation. If the result as seen in the operating room was permanent, all would be well. Unfortunately, a permanent result does not always follow. Changes frequently take place in the contour of the nose after operation, the distressing change being a dropping of the nasal tip. When this happens, the tip sags and takes on an unpleasing rounded pendulous shape, especially noticeable on profile. Secondary dropping of the tip ruins more results in rhinoplasty than any other feature of the operation. The rounded feature of the tip after it has "dropped" is

MORPHOLOGIC DEFORMITIES OF THE LOWER LATERAL CARTILAGES

IN THE article "Introduction of an Artistic Point of View in Regard to Rhinoplastic Diagnosis,"¹great emphasis is placed on the postoperative appearance of the nasal tip. In another article, "The Role of Columellar and Septocolumellar Sutures in Rhinoplasty,"²it is stated that about 90 per cent of all artistic errors are centered around the nasal tip, involving the columella, the nostrils, the septolabial angle and the philtrum. Since the lower lateral cartilages form the major portion of the lower cartilaginous vault, it can readily be seen that they play an extremely important part in the appearance of the nasal tip. It naturally follows that one cannot consider a rhinoplasty adequate or complete if the correction of deformities of these cartilages is neglected. To avoid modeling them is equivalent to retaining a bony hump when its removal is clearly indicated. This outstanding fault of many nasal reconstructions is due to

RETAINING A CORRECT SEPTOLABIAL ANGLE IN RHINOPLASTY

For many years rhinoplastic surgeons have been confronted with the problem of preventing a widening or a weblike distortion of the septolabial angle following the classic procedure for shortening the nose, i. e. (1) transsection of the membranous septum down to the anterior nasal spine of the maxilla, (2) reduction of the septum and upper lateral cartilages and (3) reattachment of the columella to the septum. In carrying out step 3 overcorrection is essential to compensate for the subsequent inevitable contraction due to cicatrization of the transfixed membranous septum. With this in mind, Jacques Joseph, of Berlin, in 1898 devised the septocolumellar suture to raise the tip of the nose,¹and this method became the standard practice in rhinoplasty and is meticulously followed at the present time. A heavy silk suture is passed through the septal cartilage and the columella in an oblique fashion, so that when the suture is