Gradual approach to refinement of the nasal tip: surgical results

Carvalho, Thiago Bittencourt Ottoni de; Thomazi, Emerson; Leutz, Rafael Panizza; Souza, Rafael P.S.F.; Molina, Fernando Drimel; Piatto, Vânia Belintani; Maniglia, José Victor

doi:10.1016/j.bjorl.2014.04.003

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Original Articles • Braz. j. otorhinolaryngol. 81 (1) • Jan-Feb 2015 • https://doi.org/10.1016/j.bjorl.2014.04.003 copy

Gradual approach to refinement of the nasal tip: surgical results ^☆ ☆ Please cite this article as: de Carvalho TB, Thomazi E, Leutz RP, Souza RP, Molina FD, Piatto VB, et al. Gradual approach to refinement of the nasal tip: surgical results. Braz J Otorhinolaryngol. 2015;81:31-6.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Introduction:

The complexity of the nasal tip structures and the impact of surgical maneuvers make the prediction of the final outcome very difficult. Therefore, no single technique is enough to correct the several anatomical presentations, and adequate preoperative planning represents the basis of rhinoplasty.

Objective:

To present results of rhinoplasty, through the gradual surgical approach to nasal tip definition based on anatomical features, and to evaluate the degree of patient satisfaction after the surgical procedure.

Methods:

Longitudinal retrospective cohort study of the medical charts of 533 patients of both genders who underwent rhinoplasty from January of 2005 to January of 2012 was performed. Cases were allocated into seven groups: (1) no surgery on nasal tip; (2) interdomal breakup; (3) cephalic trim; (4) domal suture; (5) shield-shaped graft; (6) vertical dome division; (7) replacement of lower lateral cartilages.

Results:

Group 4 was the most prevalent. The satisfaction rate was 96% and revision surgery occurred in 4% of cases.

Conclusion:

The protocol used allowed the implementation of a gradual surgical approach to nasal tip definition with the nasal anatomical characteristics, high rate of patient satisfaction with the surgical outcome, and low rate of revision.

Rhinoplasty; Nose; Nasal cartilages

Group	Anatomic characteristics	Chosen technique for nasal tip definition	Usually associated techniques
1	Satisfactory definition of the nasal tip	None	Reduction of the caudal septum, reduction of the dorsum, and lateral osteotomies
2	Slightly divergent nasal tip definition points and thin skin	Interdomal breakup	Reduction of the caudal septum, reduction of the dorsum, and lateral osteotomies
3	Normal intercrural distance, slightly bulbous nose and thin skin	Cephalic trim	Reduction of the caudal septum, reduction of the dorsum, and lateral osteotomies
4	Bulbous, boxy, or asymmetric nasal tip, increased angle of divergence and/or broad domal arc and thin/normal skin	Domal suture	Domus lateralization, intercrural columellar strut, alar rim grafts, reduction of the dorsum, and lateral osteotomies
5	Bulbous, boxy or asymmetric nasal tip, increased angle of divergence, and/or broad domal arc, and thick skin	Shield-shaped graft	Domus lateralization, intercrural columellar strut, alar rim grafts, reduction of the dorsum, and lateral osteotomies
6	Amorphous nasal tip with thick skin and Fitzpatrick type V or VI (African-descendants)	Vertical dome division	Caudal septum extension, shield-shaped grafts, alar contour graft, nasal dorsal augmentation, and lateral osteotomies
7	Weak or over-resected lower alar cartilage (secondary rhinoplasty, cleft lip and palate, cancer, trauma, granulomatosis)	Replacement of lower lateral cartilages	Caudal septum extension, spreader grafts, alar contour graft, shield-shaped graft, nasal dorsal augmentation, and lateral and paramedian osteotomies

Groups	Gender		p ^a
	Male, n (%)	Female, n (%)
1 (n = 138)	62 (11.7)	76 (14.3)	0.0003
2 (n = 39)	11 (2)	28 (5.3)
3 (n = 123)	27 (5)	96 (18.1)
4 (n = 144)	30 (5.6)	114 (21.4)
5 (n = 43)	12 (2.2)	31 (5.8)
6 (n = 23)	7 (1.3)	16 (3)
7 (n = 23)	9 (1.7)	14 (2.6)

Groups	Gender		p
	Male	Female
1	26.1 ± 9.2	27.3 ± 10.5	0.7223^a
2	25.8 ± 10.1	26.0 ± 7.4	0.6397^a
3	26.8 ± 7.7	26.4 ± 7.2	0.8140^a
4	26.9 ± 8.1	27.7 ± 8.2	0.6106^a
5	28.2 ± 12.3	27.9 ± 5.8	0.9426^b
6	26.6 ± 5.1	29.6 ± 7.9	0.3606^b
7	28.7 ± 10.1	25.2 ± 8.6	0.7289^a

Groups	Patients satisfied after surgery		Patients unsatisfied after surgery		Satisfaction rate, n (%)
	Male, n (%)	Female, n (%)	Male, n (%)	Female, n (%)
1 (n = 138)	60 (43)	73 (53)	2 (2)	3 (2)	133 (96)
2 (n = 39)	11 (28)	26 (67)	0 (0)	2 (5)	37 (95)
3 (n = 123)	27 (22)	92 (75)	0 (0)	4 (3)	119 (97)
4 (n = 144)	28 (19)	108 (75)	2 (1)	6 (5)	136 (94)
5 (n = 43)	12 (28)	30 (70)	0 (0)	1 (2)	42 (98)
6 (n = 23)	7 (30)	16 (70)	0 (0)	0 (0)	23 (100)
7 (n = 23)	9 (39)	13 (56)	0 (0)	1 (5)	22 (96)
Total (n = 533)	154 (29)	358 (67)	4 (1)	17 (3)	512 (96)

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] ^∗Corresponding author. E-mail:cmf.thiago@gmail.com (T.B.O. de Carvalho).

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Gradual approach to refinement of the nasal tip: surgical results ☆ ☆ Please cite this article as: de Carvalho TB, Thomazi E, Leutz RP, Souza RP, Molina FD, Piatto VB, et al. Gradual approach to refinement of the nasal tip: surgical results. Braz J Otorhinolaryngol. 2015;81:31-6.

Introduction:

Objective:

Methods:

Results:

Conclusion:

Gradual approach to refinement of the nasal tip: surgical results ^☆ ☆ Please cite this article as: de Carvalho TB, Thomazi E, Leutz RP, Souza RP, Molina FD, Piatto VB, et al. Gradual approach to refinement of the nasal tip: surgical results. Braz J Otorhinolaryngol. 2015;81:31-6.