title: Precise anatomical study of rhinoplasty: description of a novel method and application to the lateral crural steal.
abstract: OBJECTIVE
  The prediction of nasal tip position in terms of projection, rotation, and length is a major challenge in rhinoplasty. Studies using preoperative and postoperative photographs lack accuracy owing to variable position, and computer-simulated models lack clinical applicability.
  
  
  OBJECTIVE
  (1) To describe an accurate and reproducible technique to study the effect of surgical manipulations on the nasal tip; and (2) to describe the effect on the nasal tip cartilages of the lateral crural steal (LCS).
  
  
  METHODS
  Cadaveric study in a tertiary hospital center using 10 cadaveric specimens.
  
  
  METHODS
  Heads were placed in a Mayfield head holder, and a 12.2-megapixel camera was fixed on a tripod in a perfectly still position and focused on the surgical field during all surgical manipulations. An external rhinoplasty approach was performed for all specimens, and a 4-mm LCS was achieved.
  
  
  METHODS
  Measures include tip projection, tip rotation, and nasal length using preoperative and postoperative photographs.
  
  
  RESULTS
  Our method was successfully performed on all specimens: LCS resulted in a significant mean increase in projection using the Goode ratio (mean, 0.05; P = .005) and rotation (mean, 13.2°; P = .005). However, absolute tip projection variation was inconsistent, ranging from -1.0 mm to 0.6 mm. Nasal length was significantly shortened in all cases (mean, 1.3 mm, P = .005).
  
  
  CONCLUSIONS
  We describe the first technique for precise anatomical study of tip position in rhinoplasty on cadaveric specimens. This technique was successfully applied to 10 consecutive nasal tips. We have shown a significant increase in projection using the Goode ratio and rotation with LCS. However, the effect on absolute projection is inconsistent.
  
  
  METHODS
  NA.
authors.affiliation: Otolaryngology-Head and Neck Surgery Service, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.
authors.forename: Sami P
authors.initials: SP
authors.lastname: Moubayed
authors.affiliation: Otolaryngology-Head and Neck Surgery Service, Fleury and Lakeshore General Hospital, Montreal, Quebec, Canada.
authors.forename: Zahi
authors.initials: Z
authors.lastname: Abou Chacra
authors.affiliation: Facial Plastic Surgery Associates, Houston, Texas.
authors.forename: Russell W
authors.initials: RW
authors.lastname: Kridel
authors.affiliation: Otolaryngology-Head and Neck Surgery Service, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.
authors.forename: Christian
authors.initials: C
authors.lastname: Ahmarani
authors.affiliation: Otolaryngology-Head and Neck Surgery Service, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.
authors.forename: Akram
authors.initials: A
authors.lastname: Rahal
mesh_terms: D002102:Cadaver; D006801:Humans; D055171:Nasal Cartilages / Q000601:surgery; D009666:Nose / Q000033:anatomy & histology* / Q000601:surgery; D010781:Photography; D015203:Reproducibility of Results; D012225:Rhinoplasty / Q000379:methods*