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Precise anatomical study of rhinoplasty: description of a novel method and application to the lateral crural steal.

IMPORTANCE
The prediction of nasal tip position in terms of projection, rotation, and length is a major challenge in rhinoplasty. Studies using preoperative and postoperative photographs lack accuracy owing to variable position, and computer-simulated models lack clinical applicability.


OBJECTIVES
(1) To describe an accurate and reproducible technique to study the effect of surgical manipulations on the nasal tip; and (2) to describe the effect on the nasal tip cartilages of the lateral crural steal (LCS).


DESIGN, SETTING, AND PARTICIPANTS
Cadaveric study in a tertiary hospital center using 10 cadaveric specimens.


INTERVENTIONS
Heads were placed in a Mayfield head holder, and a 12.2-megapixel camera was fixed on a tripod in a perfectly still position and focused on the surgical field during all surgical manipulations. An external rhinoplasty approach was performed for all specimens, and a 4-mm LCS was achieved.


MAIN OUTCOMES AND MEASURES
Measures include tip projection, tip rotation, and nasal length using preoperative and postoperative photographs.


RESULTS
Our method was successfully performed on all specimens: LCS resulted in a significant mean increase in projection using the Goode ratio (mean, 0.05; P = .005) and rotation (mean, 13.2°; P = .005). However, absolute tip projection variation was inconsistent, ranging from -1.0 mm to 0.6 mm. Nasal length was significantly shortened in all cases (mean, 1.3 mm, P = .005).


CONCLUSIONS AND RELEVANCE
We describe the first technique for precise anatomical study of tip position in rhinoplasty on cadaveric specimens. This technique was successfully applied to 10 consecutive nasal tips. We have shown a significant increase in projection using the Goode ratio and rotation with LCS. However, the effect on absolute projection is inconsistent.


LEVEL OF EVIDENCE
NA.