Closed rhinoplasty with open approach advantages: extended intranasal incisions and tip rearrangement sutures

Overview

Rhinoplasty is usually done either open, with an external incision, or closed, entirely inside the nose. The authors describe extending the incision inside the nostril so that the exposure approaches what the open method gives. They also define two new stitches for shaping and holding the tip.

Sections of note

• Fifty-six consecutive primary rhinoplasty patients, aged 18 to 51 years, mean 27.8 years.
• Surgery took place between June 2011 and June 2012, with at least one year of follow-up.
• Access was an extended infracartilaginous incision providing open style exposure.
• Two stitches were defined: a transdomal suture modification to increase the columella lobular angle, and a footplate repositioning suture to raise tip projection and set tip position.
• A satisfaction survey at the one year visit gave a 96 percent satisfaction rate.
• The authors report no overprojection, underprojection, supratip deformity, saddle nose deformity or dorsal surface irregularity at the time of writing.
• The authors state the incision allowed control of the whole nose including the nasal valve area. Level of evidence V.

What it means for a patient

• The exposure that the open approach provides can be reached without an incision across the skin between the nostrils.
• Reported results were stable at one year, but one year is short for tip position, which can drift later.
• There was no comparison group operated the open way, so the claimed equivalence is not tested.
• Satisfaction was self reported at a single visit, and the absence of deformities was reported by the operating team.

Why this paper matters

The open versus closed choice is one of the standing arguments in rhinoplasty, and hybrid incisions attempt to take the exposure without the external scar. What is unanswered is whether the shaping achieved this way holds as long as through an open approach.

Terms

• Closed rhinoplasty: surgery done entirely through incisions inside the nostrils.
• Infracartilaginous incision: a cut along the lower edge of the tip cartilage inside the nostril.
• Transdomal suture: a stitch across the tip cartilage that narrows and defines the tip.
• Footplate: the base of the inner tip cartilage where it meets the nostril floor.
• Supratip deformity: a fullness just above the tip, giving a polly beak look.