Chapter 8 Elongation of the Short Nose
Online Contents
AnimationsIn this Chapter Online at experconsult.com
The Tongue-and-Groove Technique Animation 8.1
Elongating a Short Nose with the Tongue-and-Groove Technique Animation 8.2
Pearls
• The etiologies of a short nose include iatrogenic factors, trauma, Wegener’s granulomatosis and congenital deformities.
• When discussing the short nose, it is crucial to be clear whether the deficiency is in the anterior length, the posterior length, or both.
• A patient with short nose and retracted alae with rigid, fixed soft tissues of the nose poses a significant challenge in correction of the deformity.
• Minimal anterior length deficiency can be corrected with a shield graft.
• A significant nasal length deficit will require elongation of the dorsal frame using a tongue-and-groove technique.
• The two key components of the tongue-and-groove technique for nasal elongation include bilateral extended columella struts that protrude beyond the anterocaudal septum proportional to the elongation necessary and a columella strut that accommodates both the spreader grafts as well as medial crura creating continuity.
• To be able to advance the alae effectively, it is crucial to dissect the lower lateral cartilages from the upper lateral cartilages and, if necessary, mobilize them completely and transpose them in a separate pocket caudally.
• If the intentions are to elongate the nose and gain more projection during the tongue-and-groove technique, 5–0 clear nylon is utilized to suture the spreader grafts to the columella strut in a more anterior relationship. Otherwise, these two structures are not fixed to each other to minimize nose rigidity.
• In case of inability to achieve enough length due to soft tissue limitations laterally, the compromise should be in the length of the nose rather than trying to protrude the columella, in which case, the alae will not be able to follow the central portion of the nose.
