Evaluating the Effectiveness of the Lateral Intercrural Suture to Decrease the Interdomal Distance to Improve the Definition of the Nasal Tip in Primary Rhinoplasty

Abstract

Introduction Several surgical techniques emphasizing sutures on the lower lateral cartilage have been studied by surgeons as instruments to improve nasal tip remodeling. It is already known that the domal divergence angle and its definition angle can be modified by lateral intercrural suture (LIS). Techniques for measuring these structures are not yet standardized.

Objectives Assess the efficacy of LIS using polydioxanone 4–0 absorbable thread by interdomal distance and systematize the LIS technique to improve nasal tip definition.

Materials and Methods This prospective study measured and analyzed interdomal distances measured preoperatively and perioperatively compared with 3- and 6-month postoperative measurements.

Results LIS was efficient on reducing interdomal distances.

Conclusion LIS is statistically safe and efficient and has low morbidity when utilized in patients with mild to moderate deformities, because it reduces the domal divergence angle, effectively sustaining the nasal tip.

Keywords

rhinoplasty - polydioxanone - suture techniques

• References

• 1 Garcia LC. Estudo do equilíbrio dorso-ponta na rinoplastia. Simpósio Brasileiro de Contorno Facial–SBCP; 1983. São Paulo, Brazil: SBCP; 1983: 167-170
• 2 Pitanguy I. Aesthetic Plastic Surgery of Head and Body. Berlin, Germany: Springer-Verçog; 1981: 257-301
• 3 Daniel RK, Regnault P , eds. Aesthetic Plastic Surgery. Boston, MA: Little Brown; 1993: 253-255
• 4 Gruber RP. Suture correction of nasal tip cartilage concavities. Plast Reconstr Surg 1997; 100: 1616-1617
• 5 Toriumi DM, Checcone MA. New concepts in nasal tip contouring. Facial Plast Surg Clin North Am 2009; 17: 55-90, vi
• 6 O'Neal RM, Iremberg PH, Scheleisenger J. Surgical anatomy of the nose. In: Daniel RK, Regnault P, , eds. Aesthetic Plastic Surgery. Boston, MA: Little Brown; 1993: 3-39
• 7 Rohrich RJ, Adams Jr WP. The boxy nasal tip: classification and management based on alar cartilage suturing techniques. Plast Reconstr Surg 2001; 107: 1849-1863, discussion 1864–1868
• 8 Tardy ME. Surgical Anatomy of the Nose. New York, NY: Raven Press; 1992: 36-72
• 9 Sheen JH, Sheen AP. Aesthetic Rhinoplasty. 2nd ed. St. Louis, MO: Quality Medical Publishing; 1997: 50-92
• 10 Oneal RM, Beil RJ. Surgical anatomy of the nose. Clin Plast Surg 2010; 37: 191-211
• 11 Daniel RK. The nasal tip: anatomy and aesthetics. Plast Reconstr Surg 1992; 89: 216-224
• 12 Zelnik J, Gingrass RP. Anatomy of the alar cartilage. Plast Reconstr Surg 1979; 64: 650-653
• 13 Toriumi DM. New concepts in nasal tip contouring. Arch Facial Plast Surg 2006; 8: 156-185
• 14 Pitanguy I. Aesthetic Plastic Surgery of Head and Body. Berlin, Germany: Springer-Verçog; 1981: 257-301
• 15 Tebbetts JB. Discussion: nasal tip sutures part I: the evolution. Plast Reconstr Surg 2003; 12 (8) 1146-1149
• 16 Leach JL, Athré RS. Four suture tip rhinoplasty: a powerful tool for controlling tip dynamics. Otolaryngol Head Neck Surg 2006; 135 (2) 227-231
• 17 Corrado A, Bloom JD, Becker DG. Domal stabilization suture in tip rhinoplasty. Arch Facial Plast Surg 2009; 11: 194-197
• 18 Toriumi DM, Tardy ME. Cartilage suturing techniques for correction of nasal tip deformities. Oper Tech Otolaryngol Head Neck Surg 1995; 6 (4) 265-273
• 19 Tebbetts JB. Shaping and positioning the nasal tip without structural disruption: a new, systematic approach. Plast Reconstr Surg 1994; 94: 61-77
• 20 Lo S, Rowe-Jones J. Suture techniques in nasal tip sculpture: current concepts. J Laryngol Otol 2007; 121: e10
• 21 Patrocínio LG, Patrocínio TG, Maniglia JV, Patrocínio JA. Graduated approach to refinement of the nasal lobule. Arch Facial Plast Surg 2009; 11: 221-229
• 22 Simons RL. Vertical dome division in rhinoplasty. Otolaryngol Clin North Am 1987; 20: 785-796
• 23 Song HM, Kim JS, Lee BJ, Jang YJ. Deviated nose cartilaginous dorsum correction using a dorsal L-strut cutting and suture technique. Laryngoscope 2008; 118: 981-986
• 24 Gunter JP, Friedman RM. Lateral crural strut graft: technique and clinical applications in rhinoplasty. Plast Reconstr Surg 1997; 99: 943-952, discussion 953–955
• 25 Nedev PK. Cranio-caudal transdomal sutures for the nasal tip correction. Eur Arch Otorhinolaryngol 2009; 266: 237-242
• 26 Tardy Jr ME, Patt BS, Walter MA. Transdomal suture refinement of the nasal tip: long-term outcomes. Facial Plast Surg 1993; 9: 275-284
• 27 Pitanguy I. Surgical importance of a dermocartilaginous ligament in bulbous noses. Plast Reconstr Surg 1965; 36: 247-253
• 28 Pedroza FA. A 20-year review of the “new domes” technique for refining the drooping nasal tip. Arch Facial Plast Surg 2002; 4: 157-163
• 29 Friedman O, Akcam T, Cook T. Reconstructive rhinoplasty: the 3-dimensional nasal tip. Arch Facial Plast Surg 2006; 8: 195-201
• 30 Gruber RP, Weintraub J, Pomerantz J. Suture techniques for the nasal tip. Aesthet Surg J 2008; 28: 92-100
• 31 Gunter JP. The merits of the open approach in rhinoplasty. Plast Reconstr Surg 1997; 99: 863-867
• 32 McCollough EG, English JL. A new twist in nasal tip surgery. An alternative to the Goldman tip for the wide or bulbous lobule. Arch Otolaryngol 1985; 111: 524-529
• 33 Tardy Jr ME, Patt BS, Walter MA. Transdomal suture refinement of the nasal tip: long-term outcomes. Facial Plast Surg 1993; 9: 275-284
• 34 Guyuron B, Behmand RA. Nasal tip sutures part II: the interplays. Plast Reconstr Surg 2003; 112: 1130-1145, discussion 1146–1149
• 35 Leach JL, Athré RS. Four suture tip rhinoplasty: a powerful tool for controlling tip dynamics. Otolaryngol Head Neck Surg 2006; 135: 227-231
• 36 Rohrich RJ, Raniere Jr J, Ha RY. The alar contour graft: correction and prevention of alar rim deformities in rhinoplasty. Plast Reconstr Surg 2002; 109: 2495-2505, discussion 2506–2508
• 37 Mustarde JC. Correction of prominent ear using simple mattress suture. Br J Plast Surg 1963; 16: 170-176
• 38 Tardy ME, Chemy E. Transdomal suture refinement of the nasal tip. Facial Plast Surg 1987; 4: 317-326
• 39 Oneal RM, Bell Jr RJ, Izenberg PH, Schlesinger J. Surgical anatomy of the nose. Operat Tech Plast Reconstr Surg 2000; 7 (4) 158-167
• 40 Sheen JH, Sheen AP. Aesthetic rhinoplaty. 2nd ed. Louis: CV Nosbx; 1987: p.85
• 41 Gunter JP, Rohrich R, Adams WP. Dallas rinoplastia: cirurgia do nariz pelos mestres. Rio de Janeiro: Revinter; 2006
• 42 Joseph LL, Raghu SA. Four suture tip rhinoplasty: A powerful tool for controlling tip dynamics. Otolaryngol Head Neck Surg 2006; Aug; 135 (2) 227-31