Short Nose Deformity Research Articles

Controlling Nasal Length with Extended Spreader Grafts: A Reliable Technique in Primary Rhinoplasty

The short nose characterized by a reduced distance from the nasal radix to the tip represents a challenging deformity in facial plastic surgery. Several techniques have been described in the literature for augmentation of the short nose, but none emphasizes the surgical maneuvers necessary to preserve nasal length in primary rhinoplasty and to avoid the development of a short nose deformity. The authors present a surgical technique for avoiding postoperative nasal shortness and for controlling nasal length in primary rhinoplasty. The procedure uses caudally extended bilateral spreader grafts, which prevent postoperative cephalic tip rotation and allow control of tip rotation. The grafts should be placed electively in noses that have the potential to become overshortened postoperatively. By doing so, surgeons can perform any of the common surgical maneuvers in rhinoplasty without risking short nose deformity. The study included 41 patients with a mean age of 27 years who were considered to be at high risk for the development of postoperative short nose deformity. All the patients were treated with bilateral extended spreader grafts via the open nasal approach. The follow-up period was up to 12 months, with regular evaluation of the surgical outcome comprising measurement of the nasal length and photographic analysis. All the patients showed preserved nasal length after surgery with well-proportioned facial features. There was no evidence of postoperative nasal shortening after 12 months of follow-up evaluation. No operative or postoperative complications were detected. All the patients were pleased with the surgical results achieved. The use of extended spreader grafts during primary rhinoplasty for selected patients represents a valuable tool for preventing short nose deformity after primary rhinoplasty.

Reconstruction of short nose deformity using nasolabial flaps pedicled on the infraorbital vessels

Bilateral nasolabial flaps pedicled on the infraorbital vessels, and costal cartilage grafts were used to reconstruct a severe nasal deformity caused by Wegener's granuloma. We believe this flap is another useful method for nasal reconstruction, when nasolabial flaps pedicled on the angular vessels cannot be used.

Lengthening the short nose.

In the more difficult cases of short nose deformity in which there is loss of septal membrane, lining as well as cartilage must be provided to adequately correct the functional and aesthetic deformity. A discussion of these techniques is outlined and a procedure discussed that makes use of staggered septal incisions to aid in implanting the composite conchal graft. After release of the entire inferior septal columella unit, a gap remains, which is filled by a composite conchal graft. The mechanics of the steplike incisions enable the bare-grafted cartilage, which has been denuded of conchal perichondrium, to be covered by normal septal perichondrium. The risk of perforation or graft failure is greatly reduced due to the rich blood supply of the septal mucosa, which provides nutrition to the cartilaginous surfaces. The benefits, complications, and limitations of the procedure are described.