Abstract
The cartilaginous columellar strut is a well established, commonly used graft in rhinoplasty which provides support and stability to the nasal base. The risk of such a graft is related to grafts designs, whereby the posterior aspect can cause clicking with movement across the anterior nasal spine. We present an additional unusual complication of ill-fitting maxillary dentures in an edentulous patient, previously not reported in the literature. This unique complication should alert facial plastic surgeons to use additional caution when sculpting columellar grafts in edentulous patients in order to avoid potential post-operative complications in this specific patient population.
1
Introduction
The columellar strut is a well established graft utilized for nasal tip support and refinement during rhinoplasty. Jack Anderson described his tripod concept of nasal tip dynamics in the 1960s . While the right and left lateral crura comprise two legs of the tripod, the conjoined medial crura functions as the third leg. The columellar strut was fashioned as a medial crural strut designed to improve columellar stability, nasal base and alar symmetry, and possibly improve tip support, projection, and even rotation. Complications of columellar strut placement are rare. There have been reports of clicking of the strut against the anterior nasal spine, however no other significant complications have been reported. We describe a rare and unreported complication of ill-fitting maxillary dentures after columellar strut placement in an edentulous patient. To our knowledge, no previous similar case has been previously reported. The protocol for this study was reviewed and approved by the institutional review board of the University of Medicine and Dentistry of New Jersey – New Jersey Medical School, Newark, NJ.
2
Report of a case
A 43-year-old female with a past surgical history significant for a wide local excision of a low grade mucoepidermoid carcinoma of the hard palate presented 5 years later with constant left sided nasal obstruction and external nasal deformity. She has worn upper dentures since her surgery. On anterior rhinoscopy, the patient had significant septal deviation to the left with moderate inferior turbinate hypertrophy bilaterally. Facial analysis was notable for mid and lower 1/3 nasal deviation to the right, a small dorsal hump, a flat wide bulbous tip, and a very short upper lip. Nasolabial angle was approximately 90 degrees.
The patient underwent a standard open rhinoplasty via transcolumellar and bilateral marginal incisions. Dorsal hump reduction, bilateral spreader grafts, cephalic trim leaving 7 mm of lower lateral cartilage, and tip suturing were performed. A 20 mm × 3 mm × 2 mm autologous septal cartilage graft was placed as a columellar strut ( Fig. 1 ). There were no immediate complications.
On the first follow up visit one week later, the patient complained of inability to wear her upper dentures due to a bump near the upper frenulum. Intraoral examination revealed a hard prominence into the upper gingival-labial sulcus suspicious for the inferior part of the cartilaginous columellar graft. She was taken back to the operating room one week later and an intraoral approach revealed that the hard lump was cartilage of the posterior-inferior aspect of the columellar strut ( Fig. 2 A ). The inferior portion of the cartilage was trimmed ( Fig. 2 B), the mucosa re-approximated, and the patient subsequently did well.
2
Report of a case
A 43-year-old female with a past surgical history significant for a wide local excision of a low grade mucoepidermoid carcinoma of the hard palate presented 5 years later with constant left sided nasal obstruction and external nasal deformity. She has worn upper dentures since her surgery. On anterior rhinoscopy, the patient had significant septal deviation to the left with moderate inferior turbinate hypertrophy bilaterally. Facial analysis was notable for mid and lower 1/3 nasal deviation to the right, a small dorsal hump, a flat wide bulbous tip, and a very short upper lip. Nasolabial angle was approximately 90 degrees.
The patient underwent a standard open rhinoplasty via transcolumellar and bilateral marginal incisions. Dorsal hump reduction, bilateral spreader grafts, cephalic trim leaving 7 mm of lower lateral cartilage, and tip suturing were performed. A 20 mm × 3 mm × 2 mm autologous septal cartilage graft was placed as a columellar strut ( Fig. 1 ). There were no immediate complications.
