2017-18 HSC Section 4 Green Book

Volume 139, Number 3 • Open Dorsal Approach to Rhinoplasty

Fig. 4. A 29-year-old man with airway obstruction because of a tension nose deformity caused by overprojection of the septal angle.

angle, as this maneuver can lead to changes in the nasal length, tip rotation, and projection. Overre- section of the septum or inadequate construction of the L-strut can lead to nasal collapse and saddle deformity. 14 Attention should also be paid to the height of the dorsal septum before reducing the anterior septal angle. Pollybeak deformity can result from overresection of the anterior septal angle in the setting of a high dorsal septum without prop- erly assessing the need to increase tip projection. This is caused by retropositioning of the domes of the lower lateral cartilages and prominence of the dorsal septum in the supratip area. It is impor- tant to note that the pollybeak deformity can also be caused by unexpected postoperative loss of tip projection resulting in prominence of the anterior septal angle or redundancy of thick supratip skin.

more reliable way to control tip projection than columellar strut grafts. Anterior Septal Angle Reduction Septal angle reduction can also be performed in the infrequent case of airway obstruction because of a high and deviated dorsal septum, as seen in the “tension nose.” A septal angle that is too tall suspends the cartilaginous vault in a nearly straight anterior vector, narrowing the external and internal valves. Exposure and a careful graduated resection of the anterior septal angle reduces the height of the septum and relaxes the tension on the nasal carti- lages. 12 This widens the internal and external nasal valves and relieves nasal airway obstruction. Care must be taken when resecting the anterior septal

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