The Effect of Lateral Crural Steal With Columellar Strut Graft on Nasal Tip Projection and Rotation in Primary Open Rhinoplasty
Overview
- Phase
- Not Applicable
- Status
- Recruiting
- Sponsor
- Kafrelsheikh University
- Enrollment
- 22
- Locations
- 1
- Primary Endpoint
- Nasal tip projection.
Overview
Brief Summary
The goal of this clinical trial is to assess the effect of Lateral crural steal with Columellar strut graft done in Primary Open Rhinoplasty and its long-term sustainability on nasal tip projection and nasal tip rotation.
Detailed Description
Rhinoplasty is one of the most commonly performed aesthetic procedures worldwide, with the nasal tip being the most challenging aspect of it. The nasal tip represents the most anterior projecting point of the nose and is formed by the junction of the medial and lateral crura of lower lateral cartilages.
Projection, rotation, and definition are key aspects to be controlled and achieved in the nasal tip surgery. Preservation of natural tip support is a fundamental requirement of a successful rhinoplasty.
Although excisional techniques can produce reductions in lobular width, long-term contour alterations are unpredictable and subject to stigmatic tip deformity. As a consequence, aggressive excision-based techniques are increasingly recognized as haphazard, unpredictable, and disproportionately prone to undesirable postoperative contour deformities.
The lateral crural steal (LCS) is a tissue-conservative technique of nasal tip refinement through relocation of domal apices. Hence, modifying nasal tip projection and rotation. However, the long-term stability of tip position with LCS alone can be variable. To enhance support and long-term maintenance of tip projection, a columellar strut graft -placed between the medial crura- acts as a central scaffold, unifying the nasal tip and helping to control the final nasal tip position.
The lateral crural steal technique alone can achieve improvements in nasal tip projection and rotation, but with weak medial crura, it can twist or compress down the medial crura, which will result in loss of tip height. So, in the technique being studied, combining the LCS with a columellar strut graft can provide both dynamic and static support to the nasal tip.
Study Design
- Study Type
- Interventional
- Allocation
- Na
- Intervention Model
- Single Group
- Primary Purpose
- Treatment
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to 60 Years (Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Patients seeking primary rhinoplasty for aesthetic and/or functional indications.
- •Presence of inadequate nasal tip projection and/or rotation suitable for correction using lateral crural steal with columellar strut graft.
- •Ability to provide written informed consent and comply with follow-up visits.
Exclusion Criteria
- •History of prior nasal surgery.
- •History of severe nasal trauma, altering cartilage architecture.
- •Significant functional nasal obstruction requiring complex external nasal valve reconstruction.
- •Patients with excessively wide alar base requiring alar base reduction involving vestibular sill excision (to prevent confounding on projection/rotation).
- •Patients with facial skeletal or developmental abnormalities e.g. maxillary hypoplasia, maxillary prognathism, dentofacial deformities.
- •Patients with psychiatric illness or Body Dysmorphic Disorder.
- •Significant medical comorbidities contraindicating elective surgery or general anesthesia.
- •Inability to provide informed consent or comply with follow-up.
Arms & Interventions
Primary Open Rhinoplasty
Lateral crural steal with columellar strut graft will be done in patients undergoing Primary Open Rhinoplasty
Intervention: Lateral crural steal with columellar strut graft in Primary Open Rhinoplasty (Procedure)
Outcomes
Primary Outcomes
Nasal tip projection.
Time Frame: Analysis will be done preoperatively, immediate postoperatively, and at 6-month and 1-year postoperatively.
Assessing nasal projection using Goode's ratio, which is the ratio between distance from the alar crease (vertical plane of the alar base) to the tip of the nose and distance from the nasion to the tip of the nose. The ideal ratio is between 0.55 to 0.60. Nasal tip projection will be assessed using Rhinobase® software developed by Apaydin et al (2009), which is a software for rhinoplasty that enables standardized photographic analysis, facilitates precise anthropometric measurements, and provides objective documentation of pre- and postoperative nasal parameters.
Nasal tip rotation
Time Frame: Analysis will be done preoperatively, immediate postoperatively, and at 6-month and 1-year postoperatively.
Assessing nasal tip rotation through measuring the Nasolabial angle which is the angle formed at the junction of the columella and a line drawn from the subnasale to the labrale superius, and the Nasofacial angle which is the angle between the nasal dorsum and the facial plane (glabella to pogonion). Nasal tip rotation will be assessed using Rhinobase® software developed by Apaydin et al (2009), which is a software for rhinoplasty that enables standardized photographic analysis, facilitates precise anthropometric measurements, and provides objective documentation of pre- and postoperative nasal parameters.
Secondary Outcomes
- Patient's satisfaction(The questionnaire will be conducted pre-operatively (as a baseline), 3-month and 1-year postoperatively.)
Investigators
Ahmed Elsaeed Habib
Plastic Surgery Resident
Kafrelsheikh University