Aesthetic Outcomes, Nasal Surgery, Rhinoplasty
Conditions
Keywords
Rhinoplasty, Lateral crural steal, Columellar strut, Rhinobase, Rhinoplasty Outcome Evaluation
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.
Interventions
PROCEDURELateral crural steal with columellar strut graft in Primary Open Rhinoplasty
Patients undergo primary open rhinoplasty under general anesthesia. After local infiltration, an open approach is performed using an inverted-V transcolumellar incision with bilateral marginal incisions. The skin-soft tissue envelope is elevated in the supra-perichondrial plane. Dorsal deformities are corrected and septoplasty is performed with cartilage harvest. Vestibular skin is undermined and cephalic trimming of the lateral crura is carried out. Lateral crural steal is performed by advancing the medial end of the lateral crus 3-5 mm medially using transdomal sutures after defining the new dome position. A fixed columellar strut graft is inserted between the medial crura and secured to provide central tip support. Interdomal sutures are placed. No additional projection-enhancing grafts are used. Incisions are closed and internal and external nasal splints are applied.
Sponsors
Kafrelsheikh University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
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.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Nasal tip projection. | 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 | 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
| Measure | Time frame | Description |
|---|---|---|
| Patient's satisfaction | The questionnaire will be conducted pre-operatively (as a baseline), 3-month and 1-year postoperatively. | Assessing patient satisfaction through Rhinoplasty Outcome Evaluation (ROE) Questionnaire; which is a six-question questionnaire used to assess satisfaction with aesthetic and functional results after Rhinoplasty. Each of the six items is scored on a 0-4 scale, with 0 representing the most negative response and 4 representing the most positive response. Therefore, the total score can vary from 0 to 24. In order to facilitate the comprehension of the results, the total score can be divided by 24 and multiplied by 100, so that the score can vary from 0 to 100 %. So, 24 points or 100 % means the most patient satisfaction. It's originally piloted by Alsarraf (2000). The questionnaire has an Arabic-translated version done by Alharethy S, et al. (2021) that will be used. |
Countries
Egypt
Contacts
Primary ContactAhmed Elsaeed Habib
Outcome results
None listed