Straightening of the crooked middle third of the nose poses a reconstructive challenge of significant aesthetic and functional dimensions. For this deformity, extended procedures such as extracorporeal septoplasty have been advocated. Martyn Mendelsohn, MB, BS, FRACS, presents a series of 41 patients with markedly crooked noses that he corrected using extended spreader grafts made from high-density porous polyethylene. Follow-up ranged from 6 months to 2 years. Each patient had good improvement and there were no cases of extrusion or infection. Although the procedure uses an alloplastic material, it could become a useful adjunct in the treatment of these difficult cases. We look forward to long-term follow-up results.
Alar base reduction is commonly performed in rhinoplasty. Although numerous studies describe nasal base measurements and customized alar base excisions to achieve desired results, there has been little attempt to critically analyze the postoperative results with actual measurements. In this consecutive series by Garrett H. Bennett, MD, and colleagues of 100 patients who underwent rhinoplasty, 19 required alar base excisions. Measurements showed changes in vertical flare and nostril height but no significant change in base width, flare width, or base height. No notching was noted. Although this study is limited, its results are intriguing.
A wide variety of approaches have been described to perform alar base narrowing. Russell W. H. Kridel, MD, and Richard D. Castellano, MD, performed a retrospective review of 124 patients on whom they performed alar base reduction and describe a combination of wedge excision, wedge and sill excision, and V to Y advancement to address specific anatomical deformities. This careful analysis by authors with a 20-year experience of this procedure adds insight to its benefits and pitfalls, and explains which procedure or combination of procedures would be applicable to a given patient.
Although caudal overgrowth of the septum is frequently seen in large noses and other nasal deformities, it has rarely been analyzed as an isolated entity. An overprojected columella-labial junction is a relatively common finding in patients seeking revision rhinoplasty. Caudal excess nasal deformity is defined by Richard E. Davis, MD, as overgrowth of the caudal septum and/or nasal spine resulting in an overly long nose with a protruding columella, an obtuse nasal/labial angle, and a short, forwardly sloping upper lip. The author reviews the historical background to various surgical approaches to this problem and proposes a relevant profile analysis of the nasal base. Treatments discussed include reduction of the caudal septum, the tongue-in-groove technique, and skeletal reduction. A series of case studies demonstrates the importance of a thoughtful approach to respect limitations and avoid complications.
Willem Coymans by Frans Hals (1580-1666)
Highlights of Archives of Facial Plastic Surgery. Arch Facial Plast Surg. 2005;7(2):73. doi:10.1001/archfaci.7.2.73