Nasal base reduction by alar release: a laboratory evaluation.
BACKGROUND
When reducing the broad nasal base, there is a limit to the amount of soft tissue that can be resected, beyond which the anatomy distorts and the nostrils become stenotic (if resection enters the nostril). Alar mobilization by freeing soft-tissue attachments helps. This study purported to examine the nature of those attachments and the extent of medialization.


METHODS
The supporting tissues of the ala were sequentially divided in 16 fresh hemifacial cadavers. Key structures included the following: (1) the soft tissues and pyriform ligament of the anterior maxilla, (2) the periosteum posterior to the pyriform rim (in the bony nasal vault), and (3) the soft tissues along the horizontal pyriform rim. After release of each tethering region, the ala-pyriform distance was measured.


RESULTS
After releasing the anterior maxillary periosteum and pyriform ligament along the vertical pyriform rim, the ala-pyriform distance was reduced by a mean of 1.9 mm. After releasing the periosteum posterior to the pyriform rim (in the nasal vault), it was reduced by a mean of 1.7 mm. Releasing the soft tissues (which were thick medially) of the horizontal pyriform rim reduced the mean distance 1.0 mm for a total of 4.6 mm. Medialization resulting from anterior and posterior releases was significantly greater than that from the horizontal pyriform rim (p < 0.0006 and p < 0.015, respectively), but they were not significantly different from one another.


CONCLUSIONS
This cadaver study confirmed the role of the stabilizing effect of the pyriform ligament and the periosteum lateral and posterior to the pyriform rim. The total release was substantial, suggesting a clinical means of achieving tension-free alar medialization.
Gruber
Ronald P
RP
Stanford, San Francisco, and Davis, Calif.; and Providence, R.I. From the Divisions of Plastic and Reconstructive Surgery of Stanford University, University of California, San Francisco, Brown University, and University of California, Davis.
Freeman
M Brandon
MB
Hsu
Charles
C
Elyassnia
Dino
D
Reddy
Vikram
V
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D005260:Female; D006801:Humans; D008022:Ligaments / Q000033:anatomy & histology / Q000601:surgery; D008297:Male; D008437:Maxilla / Q000033:anatomy & histology; D008875:Middle Aged; D009666:Nose / Q000033:anatomy & histology* / Q000601:surgery*; D010521:Periosteum / Q000033:anatomy & histology / Q000601:surgery; D012225:Rhinoplasty / Q000379:methods*; D040521:Subcutaneous Tissue / Q000033:anatomy & histology / Q000601:surgery