New Jersey

Disadvantages of the Columella Strut

There are very few disadvantages to the use of the columella strut. Probably the greatest disadvantage is that a submucous resection has to be added to the procedure to obtain the cartilage. In the deviated septum, this would have been accomplished in any event. When the septum is relatively straight, cartilage removal is easy and should add only minutes to the procedure. We have occasionally en-countered swelling and inflammation at the site of insertion. This is only short-lived and requires patience only. No strut has ever extruded.

	Figure 2A. Preoperative	Figure 2B. Postoperative

The surgeon must recognize the presence of a prominent nasal spine and in these cases shorten the spine and the lower portion of the septum. If this is not recognized, the strut can project excessively, producing a nasolabial angle which appears too obtuse.

Clinical Applications of the Columella Strut Perhaps the most appropriate indication for utilization of columella support is in the short columella (Figure 2).

This case illustrates the postoperative elongation of the columella as well as its ability to rotate the tip upward and produce nasal shortening in what appeared to be a long nose. This was accomplished without shortening the septum.

In revision surgery, especially to correct a "polly beak" deformity or excess supratip prominence, the strut is very useful. Figure 3A shows the preoperative profile. Postoperatively, Figure 3B, there was almost a "polly beak" effect because of lack of columella support. This was corrected by utilizing a C-strut as shown in Figure 3C.

Figure 3A. Peoperative	Figure 3B. Postoperative	Figure 3C. Post revision surgery

The large bulky nose has a marked tendency toward postoperative drooping. This case shows the effect of the columella support in preventing postoperative drooping (Figure 4).

Figure 4A. Preoperative profile view	Figure 4B. Postoperative profile view	Figure 4C. Preoperative base view	Figure 4D. Postoperative base view

	Figure 5A. Preoperative	Figure 5B. Postoperative

For the experienced rhinoplastic surgeon, the challenge of the nose that is really not bad but could look better is possibly the most difficult. To make bad better is not nearly as difficult as making good great. This case illustrates just such a problem (Figure 5).

The use of the strut helps provide a little better tip definition and slight upward rotation without nasal shortening. It also improves the convexity of the columella.

The columella strut has been a time-tested adjunct in rhinoplasty. It gives one the ability to add a dimension to the final result in rhinoplasty beyond that which the standard technique will allow. The technique is relatively simple. The indications, as described, are numerous and the disadvantage minimal.

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