Use of Lacrimal Retractor in Rhinoplasty: A Boon for the Solo Rhinoplasty Surgeon

Overview

Open rhinoplasty requires exposing multiple structures, and many surgeons still use a bidirectional cartilage-splitting approach that requires holding the lower tip cartilages apart at the midline while working on the septum. Current methods require an assistant holding hooks, or weighted hooks left to fall sideways. For septal exposure the surgeon often holds a speculum in one hand while dissecting with the other.

Sections of note

• Article type: instrument technique description. No patient numbers, outcomes or complication rates are reported.
• The device is a spring-loaded lacrimal retractor, normally used in tear duct surgery.
• Stated uses: dissecting the nasal tip, and exposing the bridge and lower septum for modification.
• Stated advantage: constant and predictable retracting force on the midline cartilages.
• Stated advantage: atraumatic to the tissue.
• Stated advantage, described as most important: the operating surgeon can use both hands.
• The author states the technique could benefit both structural and preservation rhinoplasty surgeons.

What it means for a patient

• This concerns how the operation is performed rather than what is done to the nose, and does not change the surgical plan.
• Steady rather than variable retraction reduces the chance of tearing the cartilage being held.
• The practical driver is surgeons operating without an assistant, which is common in office based practice.
• The abstract carries no findings. It reports no patient numbers, outcomes or comparison against existing methods.

Why this paper matters

Exposure determines what a surgeon can see and therefore what can be done accurately, and inadequate retraction is a routine practical obstacle rather than a theoretical one. Repurposing an existing instrument requires no new equipment. Whether it improves accuracy, shortens operating time or reduces cartilage damage is untested.

Terms

• Open rhinoplasty: surgery through an external incision on the strip between the nostrils.
• Lacrimal retractor: a small spring-loaded instrument used in tear duct surgery to hold tissue apart.
• Lower lateral cartilages: the paired cartilages forming the nasal tip and nostril rims.
• Cartilage-splitting approach: an exposure method dividing the tip cartilages to reach the structures beneath.
• Nasal speculum: a hand held instrument that opens the nostril for viewing.
• Caudal septum: the front lower edge of the wall dividing the two sides of the nose.