Expanding Indications for Dorsal Preservation Rhinoplasty With Cartilage Conversion Techniques

Overview

Preservation rhinoplasty keeps the natural bridge in place and lowers it, rather than cutting the hump off and rebuilding the roof. The author reviewed 226 primary rhinoplasty cases performed between July 2017 and August 2018 and reported the 100 that used dorsal preservation, with emphasis on cartilage only methods. Age, gender, ethnicity and technical details were collected for every case.

Sections of note

• Retrospective single surgeon review; 100 dorsal preservation cases drawn from 226 consecutive primary rhinoplasties.
• Three categories: subdorsal strip, cartilage only pushdown with separate bony pyramid modification, and cartilage reduction with separate bony pyramid modification.
• Fifty seven patients had the subdorsal strip technique, 39 the cartilage only pushdown, and 4 cartilage modification.
• Average lowering was 4.5 mm for the subdorsal strip, range 2 to 10 mm.
• Average lowering was 2.5 mm for the cartilage only pushdown, range 1 to 3.5 mm, and 2 mm for cartilage modification, range 1 to 2.5 mm.
• No patient required revision surgery of the dorsum.
• The author states more dorsums can be preserved when the bony cap is modified.

What it means for a patient

• The technique chosen appears tied to how much the bridge needs to come down, with the strip method used for the largest reductions.
• No revisions of the bridge were needed in this group, but the follow up length is not stated in the abstract.
• This is one surgeon's series with no comparison group and no patient reported outcome scores.
• Nothing here compares preservation against conventional hump removal.

Why this paper matters

Dorsal preservation returned to wide use in the late 2010s and its main open question is which noses are suitable. This series maps three technique variants to different amounts of bridge lowering. Whether the results hold beyond one surgeon, and how they compare with standard hump reduction, is not addressed.

Terms

• Dorsal preservation: lowering the natural nasal bridge rather than cutting the hump away.
• Dorsum: the bridge of the nose.
• Subdorsal strip: removal of a strip of septal cartilage under the bridge so the bridge can settle down.
• Pushdown: lowering the whole nasal framework into the face after releasing it.
• Bony cap: the small bony ridge at the top of the hump.
• Primary rhinoplasty: a first operation on a nose that has not had previous surgery.