Indications for Preservation Rhinoplasty: Avoiding Complications

Overview

Dorsal preservation was described more than 100 years ago and has recently gained prominence. The authors describe the technique, its indications and contraindications, and its complications. Its defining feature is that it does not detach the upper lateral cartilages from the septum.

Sections of note

• Review article; the abstract reports no patient numbers, no rates and no follow up.
• The sequence is septal resection at a high or low level, called SPAR A or B, preparation of the pyramid, transverse osteotomy, lateral osteotomies, and septopyramidal adjustment.
• Predictable effects are a lower radix, a lowered bridge keeping its original shape, wider nostril spacing, a wider middle third, and loss of tip projection with rounder nostrils.
• The ideal candidate benefits from those effects: a tension nose with high radix, projected dorsum, projected anterior septal angle, narrow middle third, narrow interalar distance, thin nostrils and straight ethmoid plate, and in some cases the deviated nose.
• Contraindications are a low radix, bridge irregularities, an anterior septal angle lower than the rhinion, and a wide middle third.
• The main stigmas are a very low radix, an enlarged middle third, a residual hump and saddling above the tip.
• Other issues include weak cartilages, long nasal bones and a deviated ethmoid plate.

What it means for a patient

• The technique produces side effects in every case; suitability depends on whether those effects happen to improve that nose.
• A wide middle third or low root before surgery makes it a poor fit, because it worsens both.
• Loss of tip projection is an expected consequence, not a complication.
• No rates for any listed stigma appear in the abstract.

Why this paper matters

Preservation rhinoplasty succeeds or fails on patient selection, and this article states the criteria on both sides. It frames the predictable effects as the selection tool. How often the listed stigmas occur is not quantified.

Terms

• Dorsal preservation: lowering the natural nasal bridge instead of cutting the hump off.
• Radix: the root of the nose between the eyes.
• Upper lateral cartilage: the paired cartilage forming the middle third of the nose.
• Tension nose: a narrow, overprojected nose with a tall septum.
• Interalar distance: the width between the outer edges of the nostrils.
• Rhinion: where the nasal bones meet the cartilage on the bridge.