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• W11442913 abstract "Sir:FigureSurgical destabilization of the major supporting structures of the nasal tip often occurs during rhinoplasty whether an external or endonasal approach with delivery technique is used. Unless the tip is resupported at the time of surgery, a high risk of postoperative loss of tip projection and tip ptosis is inevitable, as is the development of nasal airway obstruction.1 Toriumi1 describes the importance of reestablishing tip support. He states that before contouring the nasal tip, the surgeon must stabilize the base of the nose. The columellar strut is one of the most versatile techniques used to stabilize the triangular nasal base and to give strong support to the tip. The effectiveness of columellar struts in addressing difficult cleft nasal deformities2,3 suggests that they could be equally effective at controlling more normal anatomical elements. Since its popularization by Anderson4 as a stronger support of the nasal tip, the columellar strut has gained wide acceptance as a nasal base stabilizer in primary and secondary rhinoplasties and in nasal reconstruction. The routine use of columellar struts as an integral step in primary rhinoplasty or septorhinoplasty has been applied in over 76 consecutive patients (26 male patients and 50 female patients) with developmental or posttraumatic nasal deformities since 2006. All patients were subjected to the open (transcolumellar) approach without using any tip grafts; however, other types of grafts were used when the procedure dictated, such as spreader and dorsal augmentation grafts. The results were evaluated by three plastic surgeons in our department using the patients' photographs and categorized as very good, good, and fair according to standard cosmetic indices regarding tip projection, rotation, nasolabial angle, and columellar shape, length, and position in relation to the alar lobules. Also, patient satisfaction after the operation was documented and categorized into three categories, including very satisfied, satisfied, and unsatisfied. All patients provided written consent for use of their photographs in scholarly publications. According to different evaluators, the results were as follows: very good, n = 50 (65.8 percent); good, n = 22 (29 percent); and fair, n = 4 (5.2 percent). Regarding patient satisfaction, the percentages of very satisfied, satisfied, and unsatisfied patients were 80.3, 17.1, and 2.6 percent, respectively (Table 1). No noted complications related to columellar strut placement or its donor sites were observed, and in all patients, a consistent tip support and adequate tip projection were achieved (Figs. 1 and 2).Table 1: Patient DataFig. 1: The long-term results approximately 2 years after primary rhinoplasty with a columellar strut in a case of long humpy nose with droopy tip.Fig. 2: A patient with humpy nose and bulbous droopy tip shown 3 months after primary rhinoplasty with columellar strut.Based on literature review and these promising pilot results, we can conclude that the columellar strut gives one the ability to add an element to the final result in primary rhinoplasty beyond that which the standard technique will allow. This added step in rhinoplasty is simple, consumes little time, and has predictable immediate and long-term results without the potential use of visible tip grafts. Therefore, use of columellar struts as an integral step in each primary rhinoplasty is highly recommended because it gives the chance for using the existing anatomical elements (septal cartilage)5 as invisible grafts to achieve the desired columellar shape and position in relation to the alar lobule. It also improves and maintains the tip shape, projection, and position in relation to the nasal dorsum without compromising the structural integrity or introducing additional visible grafts. Ahmed Mabrouk Abu El-Wafa, M.Sc., M.D. Department of Plastic Surgery, Ain Shams University, Cairo, Egypt, [email protected] DISCLOSURE The author has no financial interest to declare in relation to the content of this article." @default.
• W11442913 created "2016-06-24" @default.
• W11442913 creator A5036803167 @default.
• W11442913 date "2013-01-01" @default.
• W11442913 modified "2023-09-30" @default.
• W11442913 title "Columellar Strut" @default.
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• W11442913 doi "https://doi.org/10.1097/prs.0b013e318272a0a3" @default.
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