Basic Techniques for Endonasal Rhinoplasty

Abstract

Rhinoplasty is a procedure, which modifies the esthetic and functional elements of the nose. Surgical approaches include endonasal and external incisions usually on the columella. Initially, the endonasal rhinoplasty approach was described as “closed” rhinoplasty, as this term implies that the surgeon is not able to clearly see or reach necessary regions of the nose in the course of surgery. However, the term “endonasal” seems to represent with a more proper way this type of approach. Currently, some authors still refer endonasal techniques as closed rhinoplasty; while external techniques are referred to as open rhinoplasty. The advantages of the endonasal rhinoplasty are listed as: limited dissection to regions requiring changes, allows formation of a small-sized pocket so that graft material will fit precisely without fixation, permits percutaneous fixation whenever large pockets are produced, promotes recovery preserving vascular bridges, promotes exact preoperative analysis and planning, minimal postoperative swelling, forms intact tip graft pocket, permits composite grafting to alar rims, preserves nasal tip support mechanisms, equivalent reduction in the possibility of general scarring or iatrogenic damage to the nose, ability to produce accurate alterations in situ, a more prompt and foreseeable ability to feel adjustments created onto the nose with tactile palpation, capability to produce specific changes in one piece, needs less surgical time compared with open techniques, no external columellar scar, and faster postoperative appearance of the final result.