Appendix E - Tip Support, Incisions, and Approaches

MAJOR TIP-SUPPORT MECHANISMS

•  Size, shape, and strength of lower lateral cartilages

•  Medial crural footplate attachment to caudal septum

•  Attachment of caudal border of upper lateral cartilages to cephalic border of lower lat­eral cartilages

[Nasal septum also is considered a major support mechanism of the nose.[ MINOR TIP-SUPPORT MECHANISMS

•  Ligamentous sling spanning the domes of the lower lateral cartilages (i.e., interdomal ligament)

•  Cartilaginous dorsal septum

•  Sesamoid complex of lower lateral cartilages

•  Attachment of lower lateral cartilages to overlying skin/soft-tissue envelope

•  Nasal spine

•  Membranous septum

INCISIONS: METHODS OF GAINING ACCESS

•  Intercartilaginous

•  Transcartilaginous

•  Marginal (NOT to be confused with rim incision)

•  Transcolumellar

APPROACHES: PROVIDE SURGICAL EXPOSURE

•  Cartilage-splitting

•  Retrograde

•  Delivery: Marginal + intercartilaginous incision

•  External approach: Marginal + transcolumellar incision

SCULPTING TECHNIQUES: SURGICAL MODIFICATIONS

•  Complete strip (i.e., cephalic resection) or volume reduction of lateral crura

•  Incomplete strip (dome division)

•  Transdomal/domal sutures

•  Augmentation grafting

•  Tip graft

•  Other

REFERENCES

1. Tardy ME. R/tinoplasly: the art and the science. Philadelphia : WB Saunders, 1997.
2. Tardy ME, Toriumi DM. Philosophy and principles of rhinoplasty. In: Cummings C.W. Fredrickson JM, Harker LA, et al., eds. Otolaryngology: head & neck surgery. 2nd ed. St. Louis : Mosby Year Book. 1993: 278-294.