Pollybeak

Pollybeak refers to a specific problem of the nasal dorsumdpostoperative fullness of the supratip region, with an abnormal tip-supratip relationship. This problem may have several causes, including failure to maintain adequate tip support (postoperative loss of tip projection), inadequate cartilaginous hump (anterior septal angle) removal, or supratip dead space or scar formation. Treatment of the pollybeak deformity depends on the anatomic cause [30]. The best treatment is avoidance. If the cartilaginous hump was underresected at the anterior septal angle, however, the revision surgeon should resect additional dorsal septum. Adequate tip support must be ensured; maneuvers such as placement of a columellar strut may be beneficial. If the bony hump was overresected, a graft to augment the bony dorsum may be beneficial. If a pollybeak is from excessive scar formation, triamcinolone (Kenalog) injection or skin taping in the early postoperative period should be undertaken before any consideration of surgical revision.

Overresection and saddle nose

Saddle nose refers to the appearance of the nose after loss of support of the nasal vault with subsequent collapse ( Fig. 6 ). This deformity has been described after overresection of the septum, with failure to preserve an adequate L-strut. A minimum of 15 mm of cartilage is recommended as a rule of thumbdif a dorsal hump resection also is planned, this must be accounted for in planning adequate L-strut for nasal support. Other causes of saddle nose deformity include septal hematoma, septal abscess, and severe nasal trauma. Excessive dorsal hump resection also leads to saddlenose deformity.

Fig. 5. The powered rasp (Linvatec-Hall Surgical, Largo, FL) oscillates at speeds of 15,000 rpm with minimal back-and-forth excursion of only several millimeters. The senior author finds the powered rasp more precise and preferable to manual rasping. (Copyright© Daniel Becker, MD) Fig. 6. Precise pocket, triple-layer cartilage onlay grafting effectively treated this patient's saddle-nose deformity. (Copyright© Daniel Becker, MD)

Onlay grafting can camouflage and correct mild and moderate saddle deformities effectively ( Fig. 6 ). Single or multiple layers of septal cartilage or auricular cartilage commonly are used effectively [31,32]. Severe saddlenose deformity may require major reconstruction with cantilevered cartilage or bone grafts [33,34].

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