title: Improved access in endonasal rhinoplasty: the cross cartilaginous approach.
abstract: BACKGROUND
  The popularity of open rhinoplasty has increased such that it is the first choice of approach for many surgeons undertaking primary rhinoplasty. Despite the benefits of this approach, the drawbacks are often not emphasized. We present a review, with quantitative assessment of 24 rhinoplasty patients using the cross-cartilaginous incision. This new approach optimizes access without an external scar and ligament disruption that ensues after the open approach.
  
  
  METHODS
  24 consecutive patients underwent primary rhinoplasty from March 2009 to April 2011 using the cross-cartilaginous approach. Preoperative measurements of defined anatomical sites of the nose were taken. Independent assessments of the postoperative results were undertaken by a surgical resident and a senior nurse using preoperative and postoperative photographs using the new Independent Rhinoplasty Outcome Score (IROS). Evaluation of patient satisfaction and postoperative patient concerns were carried out.
  
  
  RESULTS
  The range of preoperative measurements (average) were: radix 12-19 mm (15.0), keystone 20-34 mm (24.5), alar base 14-20 mm (17.0), nose length 48-58 mm (50.2), tip width 11-25 mm (15.9), and tip projection 21-37 mm (29.6). Three months after the operation, the patient satisfaction scores were rated 67% good to excellent, 25% were acceptable, and 8% were dissatisfied. After 3 months, 17% of patients reported swelling, 0% bruising, 8% irregularities, 8% asymmetry, and 4% airway issues. Independent assessment of the photographs showed that overall result was: 31% good, 56% average, and 13% had no improvement.
  
  
  CONCLUSIONS
  Preoperative anatomical measurement allows reliable assessment of nasal characteristics and comparison with postoperative outcomes. Our simple grading system for outcome assessment in rhinoplasty allows the assessment to be reliable and reproducible (IROS). The cross-cartilaginous approach is suitable for a majority of primary rhinoplasty patients, providing good access and visibility, although, open rhinoplasty is required for selected complex revision cases.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Department of Plastic Surgery, Wexham Park Hospital, Slough, UK. Electronic address: andycky@doctors.org.uk.
authors.forename: Kuen Y
authors.initials: KY
authors.lastname: Chin
authors.affiliation: Department of Plastic Surgery, Wexham Park Hospital, Slough, UK.
authors.forename: Rajan
authors.initials: R
authors.lastname: Uppal
mesh_terms: D000328:Adult; D004724:Endoscopy / Q000379:methods*; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D055171:Nasal Cartilages / Q000033:anatomy & histology / Q000601:surgery*; D009296:Nasal Cavity / Q000033:anatomy & histology / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods; D058996:Quality Improvement; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods*; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: Closed rhinoplasty; Cross cartilaginous approach; Outcome; Rhinoplasty