Structural Rhinoplasty through the Endonasal Approach

Overview

Shah and Nnabue review structural endonasal rhinoplasty, contrasting it with older reductive closed surgery that removed tissue and caused later collapse. Using highlighted cases, they review anatomy, preferred tools including ultrasonic devices, indications, and the main techniques: hump reduction, spreader grafts, alar batten and rim grafts, columellar strut and caudal extension grafts. No patient series is reported.

Sections of note

• Reductive rhinoplasty is described as having frequently led to poor functional and cosmetic consequences.
• Structural techniques reviewed: hump reduction, spreader grafts, alar batten and rim grafts, columellar strut, caudal extension grafts.
• Stated advantages of endonasal surgery: less swelling, less loss of tip support, less scar and contracture.
• The authors cite studies showing outcomes similar to open surgery with shorter operating time and fewer complications.

What it means for a patient

• Closed rhinoplasty is no longer limited to shaving down a nose; grafts and supports can be placed through the nostrils.
• The trade-off is reduced visibility for the surgeon, so the approach depends on the surgeon's training and the complexity of the case.
• The claimed advantages are drawn from the literature rather than the authors' own data.

Why this paper matters

It summarises the modern case for structural closed surgery, relevant as preservation and closed techniques regain popularity. Limits: review, no original outcomes.

Terms

• Endonasal approach: all incisions inside the nose.
• Reductive rhinoplasty: the older approach of removing bone and cartilage without adding support.
• Alar batten graft: cartilage placed along the side wall to prevent nostril collapse.
• Caudal extension graft: cartilage extending the front of the septum to set tip position.
• Ultrasonic device: a piezoelectric instrument for precise bone cutting.