title: Changes in nasal tip projection and rotation after septorhinoplasty: a cephalometric analysis.
abstract: OBJECTIVE
  This prospective study reports on changes in nasal tip projection and nasal tip rotation before and after septorhinoplasty analyzed cephalometrically.
  
  
  METHODS
  Forty patients undergoing primary septorhinoplasty were studied prospectively. Lateral cephalometric radiographs taken in the natural head position were obtained before and 6 to 45 months (mean, 17.1) after surgery. In 10 patients, serial radiographs were taken at 6 and 12 months, and in seven patients they were taken at 12 and 24 months after surgery. Nasal tip projection (NTP) was defined as the distance between articulare (Ar) and pronasion (PRN). Nasal tip rotation (NTR) was defined as the change in the angle (N-Ar-PRN) after surgery. A surgical goal to increase, decrease, or maintain NTP and NTR was assigned to each patient before surgery.
  
  
  RESULTS
  NTP changed in the desired direction in 16 of 40 patients (40%). NTR changed in the desired direction in 25 of 40 patients (63%). In the patients studied serially, NTP decreased an average 0.7 mm between 6 and 12 months (P = .018), and 0.6 mm between 12 and 24 months (P = .071).
  
  
  CONCLUSIONS
  Decreased NTP and NTR were the most easily achieved surgical objectives. Maintaining or increasing NTP is less predictable. Typically, there is a progressive loss of NTP after surgery independent of the surgical goal. Cephalometric analysis is a useful tool to measure changes in NTP and NTR after septorhinoplasty.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Vanderbilt University School of Medicine, Nashville VA Medical Center, TN, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Werther
authors.forename: J P
authors.initials: JP
authors.lastname: Freeman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002508:Cephalometry; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009300:Nasal Septum / Q000601:surgery*; D009666:Nose / Q000033:anatomy & histology; D011446:Prospective Studies; D012225:Rhinoplasty; D016896:Treatment Outcome