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Original Investigation |

Quantifying Changes in Nasal Tip Support

Thomas J. Willson, MD1; Tyler Swiss, DO2; Jose E. Barrera, MD3,4,5
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas
2Department of Health Education and Training, Tripler Army Medical Center, Honolulu, Hawaii
3Texas Facial Plastic Surgery and ENT, San Antonio
4Uniformed Services University of the Health Sciences, Bethesda, Maryland
5University of Texas Health Science Center, San Antonio
JAMA Facial Plast Surg. 2015;17(6):428-432. doi:10.1001/jamafacial.2015.1035.
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Importance  Imparting surgical change to the nasal tip remains one of the most challenging aspects of rhinoplasty. The surgeon must assess the tip preoperatively and execute the necessary maneuvers to impart the desired change.

Objective  To assess nasal tip resistance to compression in a cadaveric model before and after specific rhinoplasty maneuvers using a novel method.

Design, Setting, and Materials  Open rhinoplasty maneuvers were performed at an academic tertiary care center on 6 fresh-thawed cadaver heads. Assessment of tip support was performed with a motorized, computer-controlled test stand equipped with a digital load cell. Tip support was assessed by compression to a depth of 2.5 mm from contact both preoperatively and after each surgical maneuver. All force data were recorded in pound-force and converted to newtons (N) following analysis.

Main Outcomes and Measures  Nasal tip support, measured as resistance to compression, before and after various rhinoplasty maneuvers.

Results  Following the elevation of the skin–soft-tissue envelope with septoplasty, resistance to compression (1.82 N) was not significantly different from the preoperative assessment (1.60 N for all specimens). Tip support following placement of a caudal extension graft was significantly different from all other conditions (3.16 N; P < .01), showing support increased by more than 66% from preoperative assessment. Placement of columellar strut (1.28 N) did not show significant increase in tip support. Tip support was decreased slightly after placement of intradomal sutures, which was significant (1.22 N; P < .01).

Conclusions and Relevance  This study demonstrates the use of materials testing equipment to assess and quantify change in tip support after several rhinoplasty maneuvers. Minor supporting maneuvers that rely on healing and scar do not significantly alter tip support in a cadaveric model. Caudal extension graft is an important maneuver imparting significant effect on nasal tip support.

Level of Evidence  NA.

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Figure 1.
Test Stand Used to Measure Nasal Tip Support

CP indicates the compression plate; LC, the position of the load cell. Both of these devices are mounted onto the test arm, which travels up and down the column and stands perpendicular to the base.

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Figure 2.
Artist’s Depiction of the Experimental Setup

The subject head is set in the custom cylindrical cradle and oriented with the nasal tip parallel to the compression arm.

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Figure 3.
The Median Force in Newtons (N) Required to Compress the Nasal Tip Across All Conditions

The boxes represent the range of values from 25th to 75th percentiles across depths; horizontal lines, median values; whiskers show minimum and maximum values; bullets, outliers greater than 1.5 times the interquartile range; open circle above Dome Suture, extreme outlier. Septo indicates septoplasty; S-STE, skin–soft-tissue envelope elevation.

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Figure 4.
Force Applied per Compressive Interval

Average force in newtons (N) required to compress the nasal tip to specified depths; maximum depth, 2.5 mm.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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