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Cartilage flap prevents notching of keystone area in large-nose septorhinoplasty

A triangular-shaped flap of upper lateral cartilages prevented notching of the keystone area when lowering the nasal dorsum in larger noses during septorhinosplasty, according to recently published study results.

Researchers conducted a retrospective study by reviewing medical records as well as preoperative and postoperative photographs of septorhinoplasty cases in which triangular flaps were used between April 1, 2012 and March 3, 2013.

Researchers assessed demographic data, amount of hump reduction and irregularities of the dorsum in the keystone area mentioned in the medical record or identified in postoperative profile view photographs.

The study included 38 patients (mean age, 27.4 years; 25 females) with skin that was not thin who were scheduled for septorhinoplasty with flap reconstruction with more than 3 mm of dorsal hump removed.

“During stepwise resection of the nasal dorsum, a triangular shaped remnant of the most cephalomedial part of the [upper lateral cartilage (ULC)] was maintained intact on each side over the keystone area,” the researchers reported.

All patients had more than 3 mm of hump reduction. Postoperative photographs showed no irregularities of the nasal dorsum over the keystone area; digital examination of the keystone area after a mean follow-up time of 15 months also showed no irregularities.

“The triangular-shaped ULC flap provides a simple, fast and practical means to prevent keystone notching in patients with large noses and normal skin thickness who have undergone hump reduction in primary septorhinoplasty,” the researchers concluded. “When used with other methods of stabilizing the ULCs, this technique is capable of creating a smooth, integrated nasal dorsum that endures.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.