查看文章

Every rhinoplasty begins with the analysis of the patient. For this analysis it is very important to carefully assess not only the nose, but also the facial features and the morphological characteristics of the patients body. After this evaluation a list of the surgical techniques necessary to achieve the desired nose is drawn and, according to this surgical planning, the surgical approach is selected.

The surgical approach should provide adequate exposure of the nasal structures that are to be addressed by surgery, and should allow the various surgical techniques to be executed without difficulty and without jeopardizing the nasal structures. For providing adequate exposure, however, every approach has to divide or to elevate nasal cartilaginous and soft tissues structures, and this may interfere, to a certain degree, with the natural mechanisms of tip support and strength. Several nasal structures are unanimously recognised as contributing to the tip support. The factors influencing this support are usually classified as the major and the minor tip support mechanisms. The major tip support mechanisms are: the size, shape, thickness and resilience of the alar cartilages; the upper lateral cartilages attachment to the cephalic margin of the alar cartilages; the attachment of the medial crura footplates to the caudal septum. The minor tip support mechanisms are: the ligamentous sling spanning the domes of the alar cartilages; the membranous septum; the cartilaginous septal dorsum; the nasal spine; the sesamoid complex extending the support of the lateral crura to the piriform aperture; the attachment of the alar cartilages to the overlying skin and musculature.(3, 4).