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Clinical Study of Alar Anatomy and Surgery of the Alar Base

Clinical Study of Alar Anatomy and Surgery of the Alar Base Abstract Objectives: To analyze and quantify specific aspects of alar base anatomy and to identify anatomic configurations that may be correlated with specific surgical manipulations. Design: Analysis in a population of patients presenting for aesthetic nasal surgery. Setting: Facial plastic surgery practice. Patients: The photographic slides of 120 white patients who presented for consultation were reviewed. Interventions: On the base view of photographic slides, observations were made on the width of the alar base, recurvature of the alar base, thickness of the alar lobule, thickness of the alar wall, and flare of the alar wall. On the lateral view, observations were made on the vertical insertion of the ala on the face (cephalic, normal, or caudal), contour of alar rim in profile (gentle S-shape or straight), size of alar lobule (small, normal, or large), and alar-columellar relationship, with special attention to the presence of alar hooding. Main Outcome Measures: A spreadsheet program was used to analyze the incidence of each configuration and any association between various features of the alar base. Results: Anatomic diversity exists that requires a careful individual analysis for each patient. A planned surgical intervention must fit the patient's unique anatomy. Distinctive configurations of recurvature, vertical insertion, and other aspects of the alar base were observed, with special implications for the surgeon's approach. Conclusions: Anatomic diversity requires a thorough preoperative examination followed by selection of an approach that addresses the specific anatomic findings. The choice of the best alar reduction and sculpture technique ultimately relies on a precise analysis of the anatomic configuration of the patient's alar base.Arch Otolaryngol Head Neck Surg. 1997;123:789-795 References 1. Weir RF. On restoring sunken noses without scarring the face . N Y Med J . 1892; 56:449-454. 2. Ellis DA, Dindzans L. The geometry of alar base resection . J Otolaryngol . 1987; 16:46-48. 3. McKinney PW, Mossie RD, Bailey MH. Calibrated alar base excision: a 20-year experience . Aesthetic Plast Surg . 1988;12:71-75.Crossref 4. Meyer R, Kesselring U. Sculpturing and reconstructive procedures in aesthetic and functional rhinoplasty . Clin Plast Surg . 1977;4:15-22. 5. Peck G. Scupturing the alar rim . In: Techniques in Aesthetic Rhinoplasty . New York, NY: Thieme-Stratton Inc; 1990:50-51. 6. Sheen J. Aesthetic Rhinoplasty . St Louis, Mo: Mosby—Year Book Inc; 1987:252-272. 7. Ribeiro L. The nasal ala in rhinoplasty: a new approach . Ann Plast Surg . 1981; 6:448-452.Crossref 8. Adamson PA. Nasal tip surgery in open rhinoplasty . Facial Plast Surg Clin North Am . 1993;1:39-52. 9. Tardy ME. Alar reduction and sculpture: anatomic concepts . Facial Plast Surg . 1993;9:295-305.Crossref 10. Johnson CM Jr, Quatela VC, Toriumi D. Open structure rhinoplasty: the basic technique . In: Johnson CM Jr, Toriumi DM, eds. Open Structure Rhinoplasty . Philadelphia, Pa: WB Saunders Co; 1990:108-113. 11. Sykes JM, Senders CW, Wang TD, Cook TA. Use of the open approach for repair of secondary cleft lip nasal deformities . Facial Plast Surg Clin North Am . 1993; 1:111-126. 12. Torium DM, Sykes JM, Johnson CM. Management of the non-Caucasian nose . Operative Techniques Otolaryngol Head Neck Surg . 1990;1:225-233.Crossref 13. Farkas LG, Hreczko TA, Deutsch CK. Objective assessment of standard nostril types: a morphometric study . Ann Plast Surg . 1983;11:381-389.Crossref 14. Farkas LG, Cheung GC. Nostril asymmetry: microform of cleft lip palate? an anthropometrical study of healthy North American Caucasians . Cleft Palate J . 1979; 16:351-357. 15. Farkas LG, Deutsch CK, Hreczko TA. Asymmetries in nostrils and the surrounding soft tissues of the nose: a morphometric study . Ann Plast Surg . 1984;12: 10-15.Crossref 16. Farkas LG. Anthropometry of the Head and Face in Medicine . Amsterdam, the Netherlands: Elsevier Science Publishers; 1981. 17. Ofodile FA, Bokhari FJ, Ellis C. The black American nose . Ann Plast Surg . 1993; 31:209-218.Crossref 18. Matory WE Jr, Falces E. Non-Caucasian rhinoplasty: a 16-year experience . Plast Reconstr Surg . 1988;77:239-252.Crossref 19. Crumley R. Aesthetics and surgery of the nasal base . Facial Plast Surg . 1988;5: 135-142.Crossref 20. Sheen JH. Aesthetic Rhinoplasty . St Louis, Mo: Mosby—Year Book Inc; 1978. 21. Szachowicz E, Kridel RWH. Adjunctive measures in rhinoplasty . Otolaryngol Clin North Am . 1987;20:895-912. 22. Gunter JP, Rohrich RJ. Lengthening the aesthetically short nose . Plast Reconstr Surg . 1989;83:793-800.Crossref 23. Crumley R, Lanser M. Quantitative analysis of nasal tip projection . Laryngoscope . 1988;98:202-208. 24. Gunter JP, Rohrich RJ, Friedman RM. Classification and correction of alarcolumellar discrepancies in rhinoplasty . Plast Reconstr Surg . 1996;97:643-648.Crossref 25. Johnson CM Jr, Cheney ML, Maillho EA, Toriumi DM. Surgical anatomy and physiology of the nose . In: Johnson CM Jr, Toriumi DM, eds. Open Structure Rhinoplasty . Philadelphia, Pa: WB Saunders Co; 1990:9-21. 26. Tardy ME, Gennack SH, Murrell GL. Aesthetic correction of alar-columellar disproportion . Facial Plast Surg Clin North Am . 1995;3:395-406. 27. Ellenbogen R. Alar rim lowering . Plast Reconstr Surg . 1987;79:50-57. 28. Ellenbogen R, Blome DW. Alar rim raising . Plast Reconstr Surg . 1992;90:28-37.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

Clinical Study of Alar Anatomy and Surgery of the Alar Base

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References (27)

Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archotol.1997.01900080021001
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Abstract

Abstract Objectives: To analyze and quantify specific aspects of alar base anatomy and to identify anatomic configurations that may be correlated with specific surgical manipulations. Design: Analysis in a population of patients presenting for aesthetic nasal surgery. Setting: Facial plastic surgery practice. Patients: The photographic slides of 120 white patients who presented for consultation were reviewed. Interventions: On the base view of photographic slides, observations were made on the width of the alar base, recurvature of the alar base, thickness of the alar lobule, thickness of the alar wall, and flare of the alar wall. On the lateral view, observations were made on the vertical insertion of the ala on the face (cephalic, normal, or caudal), contour of alar rim in profile (gentle S-shape or straight), size of alar lobule (small, normal, or large), and alar-columellar relationship, with special attention to the presence of alar hooding. Main Outcome Measures: A spreadsheet program was used to analyze the incidence of each configuration and any association between various features of the alar base. Results: Anatomic diversity exists that requires a careful individual analysis for each patient. A planned surgical intervention must fit the patient's unique anatomy. Distinctive configurations of recurvature, vertical insertion, and other aspects of the alar base were observed, with special implications for the surgeon's approach. Conclusions: Anatomic diversity requires a thorough preoperative examination followed by selection of an approach that addresses the specific anatomic findings. The choice of the best alar reduction and sculpture technique ultimately relies on a precise analysis of the anatomic configuration of the patient's alar base.Arch Otolaryngol Head Neck Surg. 1997;123:789-795 References 1. Weir RF. On restoring sunken noses without scarring the face . N Y Med J . 1892; 56:449-454. 2. Ellis DA, Dindzans L. The geometry of alar base resection . J Otolaryngol . 1987; 16:46-48. 3. McKinney PW, Mossie RD, Bailey MH. Calibrated alar base excision: a 20-year experience . Aesthetic Plast Surg . 1988;12:71-75.Crossref 4. Meyer R, Kesselring U. Sculpturing and reconstructive procedures in aesthetic and functional rhinoplasty . Clin Plast Surg . 1977;4:15-22. 5. Peck G. Scupturing the alar rim . In: Techniques in Aesthetic Rhinoplasty . New York, NY: Thieme-Stratton Inc; 1990:50-51. 6. Sheen J. Aesthetic Rhinoplasty . St Louis, Mo: Mosby—Year Book Inc; 1987:252-272. 7. Ribeiro L. The nasal ala in rhinoplasty: a new approach . Ann Plast Surg . 1981; 6:448-452.Crossref 8. Adamson PA. Nasal tip surgery in open rhinoplasty . Facial Plast Surg Clin North Am . 1993;1:39-52. 9. Tardy ME. Alar reduction and sculpture: anatomic concepts . Facial Plast Surg . 1993;9:295-305.Crossref 10. Johnson CM Jr, Quatela VC, Toriumi D. Open structure rhinoplasty: the basic technique . In: Johnson CM Jr, Toriumi DM, eds. Open Structure Rhinoplasty . Philadelphia, Pa: WB Saunders Co; 1990:108-113. 11. Sykes JM, Senders CW, Wang TD, Cook TA. Use of the open approach for repair of secondary cleft lip nasal deformities . Facial Plast Surg Clin North Am . 1993; 1:111-126. 12. Torium DM, Sykes JM, Johnson CM. Management of the non-Caucasian nose . Operative Techniques Otolaryngol Head Neck Surg . 1990;1:225-233.Crossref 13. Farkas LG, Hreczko TA, Deutsch CK. Objective assessment of standard nostril types: a morphometric study . Ann Plast Surg . 1983;11:381-389.Crossref 14. Farkas LG, Cheung GC. Nostril asymmetry: microform of cleft lip palate? an anthropometrical study of healthy North American Caucasians . Cleft Palate J . 1979; 16:351-357. 15. Farkas LG, Deutsch CK, Hreczko TA. Asymmetries in nostrils and the surrounding soft tissues of the nose: a morphometric study . Ann Plast Surg . 1984;12: 10-15.Crossref 16. Farkas LG. Anthropometry of the Head and Face in Medicine . Amsterdam, the Netherlands: Elsevier Science Publishers; 1981. 17. Ofodile FA, Bokhari FJ, Ellis C. The black American nose . Ann Plast Surg . 1993; 31:209-218.Crossref 18. Matory WE Jr, Falces E. Non-Caucasian rhinoplasty: a 16-year experience . Plast Reconstr Surg . 1988;77:239-252.Crossref 19. Crumley R. Aesthetics and surgery of the nasal base . Facial Plast Surg . 1988;5: 135-142.Crossref 20. Sheen JH. Aesthetic Rhinoplasty . St Louis, Mo: Mosby—Year Book Inc; 1978. 21. Szachowicz E, Kridel RWH. Adjunctive measures in rhinoplasty . Otolaryngol Clin North Am . 1987;20:895-912. 22. Gunter JP, Rohrich RJ. Lengthening the aesthetically short nose . Plast Reconstr Surg . 1989;83:793-800.Crossref 23. Crumley R, Lanser M. Quantitative analysis of nasal tip projection . Laryngoscope . 1988;98:202-208. 24. Gunter JP, Rohrich RJ, Friedman RM. Classification and correction of alarcolumellar discrepancies in rhinoplasty . Plast Reconstr Surg . 1996;97:643-648.Crossref 25. Johnson CM Jr, Cheney ML, Maillho EA, Toriumi DM. Surgical anatomy and physiology of the nose . In: Johnson CM Jr, Toriumi DM, eds. Open Structure Rhinoplasty . Philadelphia, Pa: WB Saunders Co; 1990:9-21. 26. Tardy ME, Gennack SH, Murrell GL. Aesthetic correction of alar-columellar disproportion . Facial Plast Surg Clin North Am . 1995;3:395-406. 27. Ellenbogen R. Alar rim lowering . Plast Reconstr Surg . 1987;79:50-57. 28. Ellenbogen R, Blome DW. Alar rim raising . Plast Reconstr Surg . 1992;90:28-37.Crossref

Journal

Archives of Otolaryngology - Head & Neck Surgery – American Medical Association

Published: Aug 1, 1997

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