Short Nose Rhinoplasty Workup

  • Author: Joseph L Leach Jr, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: May 7, 2012
 

Laboratory Studies

  • Obtain benzoylecgonine levels for patients in whom cocaine abuse is suspected to exclude recent cocaine use. Such patients should have abstained from cocaine use for more than a year.
  • A complete blood count, serologic tests for syphilis, a tuberculin skin test, rheumatoid factor, and an erythrocyte sedimentation rate are helpful in determining infectious or autoimmune etiologies.
  • Aerobic, anaerobic, and acid-fast cultures of nasal secretions may be indicated.
  • An antineutrophil cytoplasmic antibody test, if positive, is highly specific for Wegener granulomatosis.
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Imaging Studies

  • Preoperative photographs should be taken from at least 4 different views. Most surgeons prefer 6 standard views, including frontal, right and left laterals, right and left obliques, and basal views.
  • Although not mandatory, preoperative radiography or CT scanning may indicate the extent of bone or cartilage loss.
  • Chest radiography is helpful in determining infectious or autoimmune etiologies.
  • Although plain radiographic studies and CT scanning often are performed around the time of trauma to the nose and mid face, these studies are not essential for reconstruction of the short nose. Using a careful physical examination to determine the amount of bony and cartilaginous deficiency is more reliable.
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Other Tests

  • Acoustic rhinometry is often used to verify subjective descriptions of nasal obstruction.
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Diagnostic Procedures

  • A tissue biopsy may be necessary to confirm the presence of neoplastic or autoimmune disease. Biopsies for this indication are notoriously unreliable, however. Biopsy is probably best performed when cancer is strongly suspected.
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Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Joseph L Leach Jr, MD  Associate Professor of Otolaryngology, University of Texas Southwestern Medical School

Joseph L Leach Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Cosmetic Surgery, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, Texas Medical Association, and Triological Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Gregory Branham, MD  Vice-Chair, Director, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, St Louis University School of Medicine

Gregory Branham, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, and Missouri State Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Dean Toriumi, MD  Associate Professor, Department of Otolaryngology, University of Illinois Medical Center

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Medvoy Ownership interest Management position; Cerescan Imaging Consulting; Headwatersmb Consulting fee Consulting; Venturequest Royalty Consulting

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Typical short nose deformity.
Concept of facial thirds. The distance from the hairline to the glabella approximately should equal the distance from the glabella to the base of the nose. In turn, this distance should approximate the distance from the base of the nose to the lowest point on the chin.
Nasal length (NL) represents the distance from the nasal radix to the tip. Radix height (RH) measures the distance from the dorsum to the cornea on lateral view. Nasal height (NH) measures the distance from the radix to the base of the nose.
Three of the best methods of analyzing projection: (A) the nasofacial angle, (B) the Crumley and Landser method, (C) the Goode method.
Three methods of analyzing tip rotation. Method A may be affected by chin position or a sloping forehead. Method C is inaccurate if the maxilla protrudes or if the columella is in an abnormal position. Method B is probably the most accurate, but it is difficult to employ on the operating table.
The normal flow of air through the nose should be laminar and parabolic. In the short nose, airflow typically breaks up into eddy currents, creating more resistance.
Demonstration of the nasal tripod concept. As with a tripod, if the lateral legs (lateral crura) of the nasal tip are shortened, the tip rotates upward. Upward rotation also occurs if the central leg (conjoined medial crura) is lengthened. Downward rotation occurs if the opposite maneuvers are carried out. Projection is altered by increasing or decreasing the lengths of all the legs concomitantly. With most short noses, the goal is to derotate the tip, and many operations attempt to lengthen the lateral legs of the tripod.
The columellar strut. This is a common way to restore or increase tip projection, which is typically deficient in the short nose.
One method of lengthening the lateral legs of the tripod is to insert cartilage or composite grafts into the area illustrated. This should derotate the tip and increase projection.
Use of interlocking calvarial bones to restore integrity of the collapsed nose. The dorsal strut is secured with screw(s) to the native bony dorsum. The caudal strut fits in a slot drilled in the dorsal strut. A small screw in the caudal strut acts as a stop to prevent retrodisplacement of either strut.
Two pieces of calvarial bone. One will be fashioned to serve as the caudal strut and the other as the dorsal strut.
Large permanent suture to anchor the dorsal bone strut to the periosteum around the nasal spine.
Dorsal strut in place. This will be modified to allow for the proper nasal tip projection.
Preoperative profile view.
Preoperative frontal view.
Postoperative profile view.
Postoperative frontal view.
Preoperative profile view.
Preoperative frontal view.
Postoperative profile view.
Postoperative frontal view.
 
 
 
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