PMC5811284_01
Preoperative lateral view with a total absence of distal half of the nasal columella and a boxy tip.
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F1
The nose and the septum were otherwise well developed (Fig. 1).
Schematic drawing of technique. A, Harvesting of the cephalic portion of the lateral crura with open technique. B, Design of a V-shaped internal nasal vestibular flap in the nasal floor. C, Cartilage grafts fixed between them and sutured to the caudal septum. D, The 2 wings of the V-shaped internal nasal vestibular flap raised. E, Rotation of the wings cranially and sutured in the midline. F, Lateral view of the reconstructed columella.
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F2
With an open approach, a cephalic trim of the lateral crura was performed, and 2 autogenous cartilage grafts were harvested (Fig. 2A). To correct the boxy nasal tip, we also placed horizontal mattress transdomal sutures (Fig. 2C). To obtain a coverage, a V-shaped internal nasal vestibular flap was designed in the nasal floor (Fig. 2B). The flaps were sutured together with interrupted sutures (Fig. 2D-F).
Intraoperative view of V-shaped internal nasal vestibular flap. The flap was a random-pattern consisting of 2 medial wings and a residual columella as a base.
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F3
The flap was a random-pattern one consisting of 2 medial wings and a residual columella as a base (Fig. 3).
Lateral postoperative view 1 year after surgery.
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F4
This surgical procedure has led to an immediate reconstruction of the trilaminar structure of the columella, to an aesthetic improvement of the nose-tip, and especially it has left no secondary deformities in the areas of the graft's withdrawal due to their intranasal position (Fig. 4).