Dynamics of the Columella Strut
ALVIN I. GLASGOLD, M.D.
Chairman, Department of Otolaryngology-Head & Neck Surgery, St. Peter's Medical Center and Middlesex General-University Hospital, New Brunswick, New Jersey
Clinical Associate Professor in Department of Surgery, UMDNJ-Rutgers Medical School, Piscataway, New Jersey
Read in part before the Third International Symposium on Plastic and Reconstructive Surgery of the Head and Neck, New Orleans, LA, May 4, 1979.
Accurate determination of tip position in relation to the rest of the nasal dorsum is of utmost importance in achieving the desired profile in rhinoplasty. The ability to prevent or estimate the degree of postoperative drooping of the tip can be one of the most difficult aspects of rhino-plasty.'
Methods of maintenance of tip projection have been varied. They have included Goldman's technique of suturing the transected medial crura together, utilizing permanent septocolumellar sutures, as advocated by Berman, and various forms of columellar implants. The utilization of a cartilaginous columellar implant, as described by Anderson, may be one of the most predictable means of establishing nasal tip projection and eliminating the untoward effects of the postoperative drooping tip.°
The Technique for Utilization of the Columella Strut Cartilage is obtained from the septum through a standard submucous resection. The most inferior portion of the nasal septum just adjacent to the spine is thick and usually makes a very good strut. This can be trimmed so that it is thin and narrow, about 3 mm in width and usually measures somewhere between 2.1 and 2.6 cm in length. Each end is tapered.
If this inferior portion of septum is not intact, then a similar strut may be fashioned from any appropriate part of septal cartilage which, although not as firm, may still make an adequate strut. Fresh septal cartilage taken from a previous case may also be utilized.
A vertical incision is made for about ½-¾ the length of the columella on either one or both sides. The incision is distal to the medial crura. In learning the technique, it seems that by utilizing an incision on both sides it is easier
to produce a symmetrical pocket and symmetrical placing of the strut. The skin is separated from the medial crura and a pocket is made the length of the columella and continues down to just above the premaxilla. This may be visualized by elevating the lip and seeing the bulge made by the point of the scissors. The lobule is not entered anteriorly superiorly.
The strut is usually prepared a little longer than the anticipated pocket and then trimmed down accordingly so that it just fits into the pocket without producing a stretch-ing effect on the columella. By utilizing an excessively long strut and actually stretching the columella, some increased length may be established in very selected cases.
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