The Dorsal Flattening Suture (DFS) in Dorsal Preservation Rhinoplasty

Overview

Approaching the septum with a subdorsal flap classically requires two pillars. The lower is the remaining front strip of septal cartilage still attached to the upper jaw, to which the flap is sutured. The upper is stable ethmoid bone beneath the bone cut at the root. If either is compromised, the bridge may not flatten adequately even after all blocking points are released.

Sections of note

• Article type: technique description. Level of evidence V. No patient numbers or outcomes are reported.
• Problem one: when the front septum must be replaced, tensioning the flap on an anterior septal reconstruction pushes the strut backward and upward, leaving it unstable.
• Problem two: the ethmoid bone beneath the root cut can be unintentionally disrupted or over-removed, losing control at the root.
• The dorsal flattening suture is a single suture that tightens and flattens the bridge independently, freeing the reconstruction graft from backward forces.
• The senior author states he has used it successfully for deviated noses and front septal deviations.

What it means for a patient

• Preservation rhinoplasty depends on two fixed points, and if either is missing the bridge will not settle flat.
• The most common situation described is when the front of the septum has to be rebuilt, which removes the lower anchor.
• The abstract carries no findings. It reports no patient numbers, outcomes, complication rates or follow up.
• Level V is the lowest evidence grade, reflecting a description of practice rather than a study.

Why this paper matters

Preservation rhinoplasty fails most often by the hump returning, and inadequate flattening is one route to that. Identifying the two structural dependencies and offering a fix when either fails addresses a specific mechanism. Whether the suture prevents recurrence has not been measured.

Terms

• Dorsal preservation rhinoplasty: lowering the bridge while keeping its natural surface intact.
• Subdorsal flap: a flap of septal cartilage raised beneath the bridge, as in the Cottle technique.
• Caudal strut: the front strip of septal cartilage remaining after septal surgery.
• Maxillary spine: the bony projection at the base of the nose where the septum anchors.
• Anterior septal reconstruction: rebuilding the front septum outside the nose before replacing it.
• Blocking point: tissue under tension that resists lowering of the bridge.