Adamson, P.A., Litner, J.A., Dahiya, R. | Arch Facial Plast Surg | vol. 8, 16 - 25, 2006
Rhinoplasty, Tripod TheoryAuthor: Anil P Punjabi, DDS, MD
IntroductionSurgically manipulating the nasal tip to achieve predictable results is the most difficult feature of rhinoplasty. One who can control the nasal tip is said to be able to master rhinoplasty. Anderson first proposed the rhinoplasty tripod theory. A complete comprehension of the tripod theory and the dynamics of tip projection, support, and rotation allow categorization of the different factors that may need alteration to manipulate the nasal tip.
Rhinoplasty is technically demanding, and tip surgery is an art form. It requires an in-depth knowledge of the complex three-dimensional anatomy of the nose, a complete understanding of its physiology, familiarity with the described techniques of nasal tip surgery, and a well-developed sense of aesthetics; all are essential in mastering rhinoplasty.
Incisions between the upper and lower lateral cartilages (ie, intercartilaginous incisions) and removal of the cephalic border of the lateral crura disrupts the interlocking relationship of the upper and lower lateral cartilages. The length, strength, and shape of each lateral crura produces a torque that pushes the lobular tip of the nose toward the upper lip and away from the peripheral aperture.
Nasal tip support system
The nasal tip tripod is considered to be a dynamic unit suspended and supported by surrounding rigid structures. Other major nasal tip supports include:
- The attachment of medial crural feet to the caudal end of quadrangular cartilage
- Scroll like attachment of the caudal end of upper lateral cartilage to the cephalic margin of the lateral cruraAccording to Tardy there are three major and six minor support mechanisms of nasal tip.
- Size, shape, strength and resilience of medial and lateral crura
- Attachment of medial crural foot plate to the caudal border of quadrangular cartilage
- Attachment of upper lateral cartilages (caudal border) to alar cartilages (cephalic border).