Double-Tunnel Creation in Mucoperichondrial-Mucoperiosteal Septal Flap to Preserve the Sagittal Stability of Dorsal Components in Rhinoplasty.

Abstract

Removal of the dorsal hump in structural rhinoplasty disarticulates the upper lateral cartilages (ULCs) from the septum, resulting in a loss of control over the medial and posterior displacement of the lateral nasal walls. This consequently leads to disruption of the dorsal aesthetic lines (DALs) in oblique and frontal views. The inability to control this disadvantage has been a major factor driving the search for alternative approaches, such as dorsal preservation rhinoplasty, over the past decade. We propose a novel technique for creating a double tunnel within the mucoperichondrial-mucoperiosteal septal flap to achieve reliable control over the vertical positioning of dorsal components. This method has been applied in over 2,000 cases, demonstrating favourable outcomes in preserving mid-vault stability while allowing for precise manipulation of the hump and other dorsal characteristics in structural rhinoplasty.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .