16 Complexity of Events
The nose is a complex of anatomic structural elements invested by a fibroaponeurotic sheath (the superficial musculoaponeurotic system, SMAS), which binds the elements together and maintains a tension that is important for function and aesthetics. Our case report of a primary and revision septoplasty will illustrate the potentially complex effects of nasal surgery that divides the fibrous attachments between the structural elements of the nasal tip without altering the tip shape itself. Shortening the anterior septum can lead to a loss of nasal tip projection with lateral flaring of the alar cartilages. 1 Weakening or dividing the fibrous attachments between the domes of the alar cartilages leads to a generalized loss of tension in the tip and supratip area. This is true despite histologic studies showing that a long-postulated interdomal ligament per se does not exist. The framework of the nasal tip, normally held in tension by the soft-tissue envelope of connective tissue, subcutaneous tissue, and skin, may lose its shape in an unpredictable way. The results are lateral flaring of the alar cartilages, depression of the supratip area, and drooping of the nasal tip with cephalic or caudal rotation.
The case report also illustrates the reconstructive steps that are always necessary when this system is destabilized by approaches such as hemitransfixion incisions, the creation of large columellar pockets, nasal tip approaches, etc. 2
Case 1
Introduction
A 40-year-old woman underwent septoplasty and noticed a marked, complex change in the appearance of her nose just a few weeks after the operation. She desired a prompt restoration of the old shape, especially with regard to straightening and narrowing of the tip and the correction of dorsal saddling.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
