Resistance Measurements with Dynamometer in Foundation Dorsal Preservation Rhinoplasty Techniques

Berber V, Gode S.

PubMed 40204933 Publisher (DOI)Free full text (PMC)

What this paper says

Measuring the springback force of the nasal bridge with a dynamometer at four stages of surgery in 12 patients, each additional maneuver significantly reduced the resistance pushing the bridge back up.

Overview

Hump recurrence after dorsal preservation is attributed to tissues that resist lowering, but the resistance had not been measured directly. The authors placed a dynamometer probe on the rhinion, the point where nasal bone meets cartilage, and recorded the pressure produced by the bridge springing back at four successive stages of a closed approach operation.

Sections of note

Design: prospective study, 12 patients at one university hospital, September to December 2022. Level of evidence III.
Four measurement stages: push down, let down, lateral keystone dissection, and rasping.
6 women and 6 men, mean age 29.9 years. Mean follow up 36.6 months. Nose types: 3 straight, 7 tension, 2 kyphotic.
Scores at all four stages were statistically significant, and significant differences were found between push down and let down, let down and keystone dissection, and keystone dissection and rasping, all p less than 0.001.
Comparing nose types, straight versus kyphotic differed significantly, p less than 0.05; tension noses did not differ significantly from other types.
Stated conclusion: severely angled kyphotic humps need additional maneuvers including removing the bony cap.

What it means for a patient

The bridge physically pushes back after being lowered, and this study measures that force rather than inferring it.
Each additional release step reduced the springback further, which supports the practice of releasing multiple points rather than one.
Sharply angled humps resisted most, which is why the authors advise extra steps for those noses.
Limits: 12 patients, one centre, and the measurements were taken during surgery with no link to whether the hump actually recurred afterward.

Why this paper matters

Hump recurrence is the recognized failure mode of dorsal preservation, and the blocking point concept has been argued anatomically rather than measured. Putting numbers on the resistance at each stage makes the argument testable. Whether lower measured resistance predicts a lower recurrence rate is not shown here.

Terms

Dynamometer: an instrument measuring force or pressure.
Rhinion: the point on the bridge where nasal bone meets cartilage.
Push down and let down: lowering the bridge by sinking it or by removing a bone wedge first.
Lateral keystone area: the side junction where nasal bone meets the upper lateral cartilage.
Rasping: filing bone to smooth or reduce it.
Kyphotic nose: a nose with a sharply angled hump on the bridge.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Introduction And Aim: Some recommendations have been reported about nasal hump recurrence and its possible reasons or mechanisms after dorsal preservation rhinoplasty. In this study, we aimed to measure how additional maneuvers affect recoil on the dorsum with the help of a dynamometer during the dorsal preservation rhinoplasty operation.

Materials And Methods: Twelve patients who underwent closed approach dorsal preservation rhinoplasty at the Ege University Hospital ENT department between September and December 2022 were included in this prospective study. During the dorsal preservation rhinoplasty operation in all patients, the pressure values caused by the recoil of the dorsum on the probe of the dynamometer placed on the rhinion were measured and recorded in 4 steps. (1: Push down (PD), 2: Let down (LD), 3: Lateral keystone dissection, 4: Rasping) RESULTS: Of the 12 patients included in the study, 6 (50%) were female and 6 (50%) were male. The mean age was found to be between 29.9 ± 6.5 (minimum 22-maximum 42). Mean follow-up time was 36.6 ±15.3 (minimum 15 -maximum 60). 3 patients (25%) had a straight nose, 7 patients (58.3%) had a tension nose and 2 patients (16.7%) had a kyphotic nose. The scores of all four stages measured were statistically significant (p < 0.001). In the comparison of the stages against each other, there were significant differences between PD-LD, LD-LKA dissection, and LKA dissectionrasping (p < 0.001). The scores of all four stages measured were statistically significant (p<0.001). In the comparison of the stages against each other, there were significant differences between PD-LD, LD-LKA dissection, and LKA dissection-rasping (p < 0.001). In the comparative analysis of nose types with each other, the difference between straight nose and kyphotic nose was found to be significant (p < 0.05). There was no significant difference between tension nose and other nose types (p > 0.05). There were differences in pressure values according to nose types (Straight, Tension, Kyphotic) and all nose types were found to be statistically significantly affected by additional maneuvers.

Conclusion: The effect of maneuvers performed on areas defined as resistance points in dorsal preservastion rhinoplasty have been evaluated with objective measurement methods. In selected cases, noses with severely angled and kyphotic humps require additional maneuvers, including resection of the bony cap, to flatten the nasal dorsum and the cartilaginous roof.

Level Of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).