Commentary |

Anatomic Considerations in the Management of the Hanging Columella

Peter A. Adamson, MD
Arch Facial Plast Surg. 2000;2(3):178-179. doi:.
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THE article by Joseph and Glasgold1 reviews a not uncommon, but not always managed, anatomic problem in cosmetic rhinoplasty. As such it bears interest for both the younger rhinoplasty surgeon and the experienced surgeon seeking new concepts in the management of nasal deformity. The central thesis of their article is that the primary cause of the hanging columella is a congenital C-shaped curvature of the medial crura. The study of 10 patients is not large, but is well presented anatomically, intraoperatively, and photographically.

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Figure 1.

Angle division to shorten the medial crural–lateral crural tripod length, thereby narrowing the domal arch and correcting the hanging columella.

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Figure 2.

Vestibular margin skin or composite skin cartilage grafts may be used to manage the true hanging columella

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Figure 3.

Correction of the true hanging columella by fusiform excision of the caudal cartilaginous septum and membranous septum, with the maximum width of excision at the point of the maximal hanging columella effect.

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