Download PDF
Facial Plast Surg 2018; 34(01): 102-106
DOI: 10.1055/s-0036-1598014
Rapid Communication
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Hemitransdomal versus Dome-Binding Suture

Fernando Casanueva
1   Department of Otolaryngology, San Vicente de Arauco Hospital, Concepcion, Chile
,
Deniz Gerecci
2   Department of Otolaryngology, Oregon Health and Science University (OHSU), Portland, Oregon
,
Felipe Cardemil
3   Department of Otolaryngology, Clínica Las Condes, Santiago, Chile
› Author Affiliations
Further Information

Publication History

Publication Date:
26 December 2017 (online)

    Permissions and Reprints

Abstract

The dome-binding suture (DBS) and hemitransdomal suture (HTS) are suture techniques used to narrow and define the nasal tip. The DBS can create a pinched, unnatural appearance, while the HTS puts the lateral crus in a more favorable orientation. This allows a natural contour between the nasal tip and alar lobule while maintaining alar margin support. Objective measurement of the rotational axis of the lateral crus between the DBS and the HTS has not been reported in the literature. To determine whether the DBS or HTS technique results in a more favorable rotational axis of the lateral crus as measured by the alar surface septal angle (ASSA). Open rhinoplasty with cephalic trim and placement of a DBS or HTS was performed in 6 cadaveric heads, for a total of 12 lower lateral cartilages at the VirtuOHSU Simulation and Surgical Training Center at Oregon Health and Science University (OHSU). ASSA measurements were taken at baseline and after placement of either a DBS or HTS. A total of 36 ASSA measurements were obtained. The median baseline ASSA prior to suture placement was 142 degrees (interquartile range [IQR]: 131.5–145 degrees), following DBS placement was 141 degrees (IQR: 33–150.5 degrees), and following HTS placement was 112 degrees (IQR: 108–117 degrees). There was no statistically significant difference of ASSA measurements between baseline and DBS placement (p = 0.24), but there was a statistically significant difference between baseline and HTS (p < 0.0001) and between DBS and HTS (p < 0.0001). The HTS technique creates a more favorable rotational axis of the lateral crus as compared with the DBS, as measured by the ASSA. This study provides objective data to support the use of the HTS for nasal tip contouring.

Keywords

rhinoplasty - nasal tip contour - suture techniques
 

  • References

  • 1 Toriumi DM. New concepts in nasal tip contouring. Arch Facial Plast Surg 2006; 8 (03) 156-185
    CrossrefPubMedGoogle Scholar
  • 2 Guyuron B, Behmand RA. Nasal tip sutures part II: the interplays. Plast Reconstr Surg 2003; 112 (04) 1130-1145 , discussion 1146–1149
    CrossrefPubMedGoogle Scholar
  • 3 Daniel RK. The nasal tip: anatomy and aesthetics. Plast Reconstr Surg 1992; 89 (02) 216-224
    CrossrefPubMedGoogle Scholar
  • 4 Toriumi DM. Structural approach to primary rhinoplasty. Aesthet Surg J 2002; 22 (01) 72-84
    CrossrefPubMedGoogle Scholar
  • 5 Dosanjh AS, Hsu C, Gruber RP. The hemitransdomal suture for narrowing the nasal tip. Ann Plast Surg 2010; 64 (06) 708-712
    CrossrefPubMedGoogle Scholar
  • 6 Çakir B, Doğan T, Öreroğlu AR, Daniel RK. Rhinoplasty: surface aesthetics and surgical techniques. Aesthet Surg J 2013; 33 (03) 363-375
    CrossrefPubMedGoogle Scholar
  • 7 Casanueva F, Gerecci D. Objective comparison of nasal tip contours in the basal view between dome binding and hemitransdomal tip suture techniques in rhinoplasty. JAMA Facial Plast Surg 2016; 18 (06) 481-487
    CrossrefPubMedGoogle Scholar
  • 8 Kovacevic M, Wurm J. Cranial tip suture in nasal tip contouring. Facial Plast Surg 2014; 30 (06) 681-687
    Article in Thieme ConnectPubMedGoogle Scholar