Journal archive · Nasal tip · Septum, valve and airway · Ethnic, Asian, Middle Eastern, African and Latino rhinoplasty · Anatomy and nasal analysis · 2017
Middle Eastern Rhinoplasty: Relationship of the Nasal Spine and Caudal Septum to Tip Projection and Columellar-Labial Angle
Arden RL, Baldwin BJ, Coffey MP.
In the archive as a landmark paper: the core sweep runs 2011–2026, and this one is here because the history of rhinoplasty rests on it · cited on middle eastern rhinoplasty.
Abstract
Objective: To measure the anterior nasal spine length (ANSL) and septal caudal extension (SCE), as well as assess the strength of association between these variables and tip projection in the Middle Eastern nose. Our secondary aim was to assess if columellar-labial angle (CLA) or columellar-spinal angle (CSA) vary as a function of ANSL and/or SCE.
Study Design/Setting: Prospective single institutional study.
Subjects: Middle Eastern primary rhinoplasty patients without nasal trauma or prior endonasal surgical history.
Methods: Photographic and intraoperative caliper measurements were used to determine Goode ratio (GR), CLA, CSA, ANSL, and SCE. Associations between numeric variables were examined with scatterplots, including use of LOWESS curves and Pearson correlation coefficients. Linear regression models were used for predicting quantitative variables (GR, CLA, CSA). Logistic regression models were used for predicting overprojection status based on GR.
Results: In total, 102 patients met inclusion criteria (82 females, 20 males). Mean ANSL and SCE were 8.6 mm and 14.9 mm, respectively; ANSL and SCE had a strong positive association with each other. SCE and ANSL were found to have low predictability for GR, CLA, or CSA.
Conclusion: Determinations of projection status using the GR method do not appear to be related to ANSL or SCE values in our Middle Eastern study group. Relationships of absolute columellar-labial or columellar-spinal angles are likely more complex than isolated value implications of SCE or ANSL.
Abstract as indexed by PubMed; the article is open access (PubMed Central).
Citation
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What the rhinoplasty literature says on this paper's topics, cited line by line to PubMed.
Nasal tip
Tip surgery is now a support problem rather than a sculpting problem: the septal extension graft holds projection and rotation where the columellar strut loses them (0.2% against 4.7% projection loss at one year), and the current series repair, reposition and reinforce the lower lateral cartilages instead of excising them.
Septum, valve and airway
Every rhinoplasty is a breathing operation whether it intends to be or not: the septum holds the nose up as well as dividing it, and the narrowest part of the whole airway is the internal valve the surgeon is standing over.
Ethnic, Asian, Middle Eastern, African and Latino rhinoplasty
The nose in front of the surgeon decides the operation, not the patient's ancestry: skin thickness, cartilage strength and existing dorsal height set the limits of what any technique can deliver, and planning every nose toward one Caucasian ideal is the error the comparative data now names.
Anatomy and nasal analysis
Before any technique is chosen, the nose has to be read: the bone measured, the cartilage counted, the skin assessed, and the result the patient wants agreed on a photograph that is not yet true.
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