Dorsal Preservation Rhinoplasty: Core Beam Computed Tomography Analysis of the Nasal Vault, Septum, and Skull Base-Its Role in Surgical Planning

Overview

Dorsal preservation drops the whole nasal roof rather than removing the hump, and doing so requires a cut at the root of the nose. That cut sits close to the skull base and the frontal sinus. This article argues imaging beforehand shows the anatomy that determines how the cut and the septal release should be made.

Sections of note

• Dorsal preservation is described as having significant advantages over resection and reconstruction in convex or over-projected noses.
• Analysis of the septum beneath the bridge in relation to the radix osteotomy is important for a controlled drop or hinge of the natural bridge.
• The complications to be avoided involve the skull base, the frontal sinus, and the resulting position of the radix.
• In the majority of patients, a simple cut release of the perpendicular plate may suffice rather than removing it from above.
• That applies where the junction of the quadrangular cartilage with the perpendicular plate lies below the level of the radix osteotomy.
• Computed tomography delineates that junction position, and also shows the frontal sinus and the cribriform plate before surgery.

What it means for a patient

• The bone cut at the root of the nose sits close to the base of the skull, which is why imaging is proposed beforehand.
• Where the cartilage meets the bone inside the nose varies between people and determines what the surgeon must do there.
• A scan also shows the frontal sinus, which the cut could otherwise enter.
• This is a review with no patient numbers or outcomes, so it does not show that routine scanning reduces complications.

Why this paper matters

Dorsal preservation has spread quickly, and its bone cut approaches structures conventional rhinoplasty does not. No complication rates with or without scanning are reported.

Terms

• Dorsal preservation rhinoplasty: Lowering the bridge as a single unit rather than removing its surface.
• Radix osteotomy: A bone cut made at the root of the nose, between the eyes.
• Perpendicular plate: The bony upper part of the nasal septum, extending toward the skull base.
• Quadrangular cartilage: The main cartilage plate of the septum.
• Cribriform plate: The thin perforated bone at the skull base above the nose.
• Cone beam computed tomography: A low-dose CT scan used for facial imaging.