Modification of Push-Down Rhinoplasty with Maxilla-Pyramid Sutures

Overview

The late result of a push down procedure depends on stably fixing the bony framework in its new lowered position. Surgeons have sought an effective way to fix the bone and cartilage roof, but the authors state all described techniques are less effective or ineffective when a septoplasty is performed at the same time. They therefore adopted fixation at the sides instead.

Sections of note

• Technique article; the journal assigns level of evidence IV.
• The abstract reports no patient numbers, no outcomes, no complication rates and no follow up.
• Stable fixation of the bony pyramid is described as the key determinant of the late outcome.
• Existing fixation techniques are stated to be less effective or ineffective when a septoplasty is also required.
• Lateral fixation of the bony pyramid was judged more relevant in those cases.
• A needle piezotome is used to make two holes, above and below the lateral bone cut lines, on both sides.
• The lowered framework is then fixed with sutures passing through those holes to the upper jaw bone.

What it means for a patient

• After the framework is lowered it must be held in position while it heals, or the bridge can rise again.
• Septum surgery removes the structure that most fixation methods anchor to, which is the problem this technique addresses.
• Anchoring to the upper jaw bone provides a fixed point independent of the septum.
• No results are reported, so the technique's effect on hump recurrence is unknown.

Why this paper matters

Hump recurrence after preservation surgery is attributed largely to inadequate fixation, and combining the procedure with septum surgery removes the usual anchor. This article proposes a bone anchored alternative. Whether it reduces recurrence has not been tested.

Terms

• Push down: lowering the nasal framework into the face after releasing it.
• Bony pyramid: the bony upper part of the nasal framework.
• Osseocartilaginous vault: the combined bone and cartilage roof of the nose.
• Lateral osteotomy: the bone cut along the side of the nose.
• Piezotome: a powered instrument that cuts bone with high frequency vibration.
• Septoplasty: surgery to straighten the central partition of the nose.