Rhinoplasty Incisions - Types, Indications, Advantages & Disadvantages
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👃 Incisions in Rhinoplasty
The choice of incision in rhinoplasty depends on:
- Surgical approach (open or closed)
- Type of deformity
- Need for exposure
- Whether it is a primary or revision surgery
- Presence of tip involvement
- Preference of the surgeon
📋 Classification of Incisions in Rhinoplasty
| Approach | Incisions |
|---|---|
| Open (External) Rhinoplasty | Transcolumellar incision, Alar incision |
| Closed (Endonasal) Rhinoplasty | Intercartilaginous incision, Transcartilaginous incision, Infracartilaginous (Marginal) incision, Transfixion incision |
1- Intercartilaginous Incision
📍 Site
Placed internally in the soft tissue scroll area, between the caudal margin of the upper lateral cartilage and the lower lateral cartilage.
👉 The incision runs parallel to and just above the lower lateral cartilage.
📌 Indications
- Dorsal hump reduction
- Nasal bone osteotomies
- Cases with limited tip involvement or minor tip refinement
- Can be combined with the transfixion incision for full endonasal access
⚠️ Not preferable for major surgery involving the tip.
What are the advantages and disadvantages of Intercartilaginous Incision?
2- Transcartilaginous Incision
📌 Also Known As
👉 Intracartilaginous Incision
📍 Site
Made through the substance of the lower lateral cartilage (alar cartilage).
- Given 3 to 5 mm caudal to the cephalic end of the lower lateral cartilage
- Placed parallel to the caudal border of the lateral crus of the alar cartilage
What are the parts of the alar cartilage?
📌 Indications
- Trimming the cephalic end of the lower lateral cartilage for tip refinement
- Bulbous or boxy nasal tip
What are the advantages and disadvantages of Transcartilaginous Incision?
3- Infracartilaginous Incision
📌 Also Known As
👉 Marginal Incision
👉 Rim Incision
📍 Site
Given along the caudal border of the lower lateral cartilage, inside the nostril rim.
👉 Starts at the medial crural footplate and extends towards the alar rim.
📌 Indications
- Tip rhinoplasty requiring full access to the lower lateral cartilage
- Asymmetric tip or complex tip deformity
- Delivery technique for cartilage grafting
What are the advantages and disadvantages of Infracartilaginous Incision?
4- Transfixion Incision
📍 Site
Made through the membranous septum in the columella, between the medial crura of the lower lateral cartilage and the caudal septum.
What is the anatomy of the nasal septum?
What are the variants of the Transfixion Incision?
📌 Indications
- Concurrent septoplasty, as in septorhinoplasty
- Caudal septal resection
- Reduction of the nasal spine
- Columellar shortening
- Tip deprojection, as in an over-projected nose
What are the advantages and disadvantages of Transfixion Incision?
5- Transcolumellar Incision
⭐ The most commonly used incision in open (external) rhinoplasty.
📍 Site
An external incision placed transversely across the columella, commonly combined with bilateral marginal incisions inside the nose.
What are the different Types of Transcolumellar Incision?
📌 Indications
The indications for open rhinoplasty are the indications for this incision:
- Complex deformity
- Revision rhinoplasty
- Cleft nose
- Severe tip asymmetry
- Major reconstruction
- Extensive grafting
- Teaching purposes
⭐ The external approach gives students good visual access, so it is well suited for teaching.
What are the advantages and disadvantages of Transcolumellar Incision?
6- Alar Incision
📍 Site
An external incision placed at the alar facial groove, the junction of the ala with the cheek or upper lip.
👉 Placed entirely outside the nostril.
📌 Indications
1- Wide Alar Base
2- Excessive Alar Flaring
What are the advantages and disadvantages of Alar Incision?
⭐ High Yield Rapid Revision Table
| Incision | Approach | Site | Key Point |
|---|---|---|---|
| Intercartilaginous | Closed | Scroll area, between upper and lower lateral cartilages | Wide access to dorsum and bony vault, limited tip access |
| Transcartilaginous | Closed | Through the lower lateral cartilage, 3 to 5 mm caudal to its cephalic end | Good for controlled cephalic trim |
| Infracartilaginous (Marginal) | Closed | Along the caudal border of the lower lateral cartilage | Allows complete delivery of the lower lateral cartilage |
| Transfixion | Closed | Through the membranous septum in the columella | Best exposure of the caudal septum and nasal spine |
| Transcolumellar | Open | Transversely across the columella | Most common incision in open rhinoplasty |
| Alar | Open | Alar facial groove | Used for a wide alar base and alar flaring |
⭐ Exam Pearls
- Incisions in rhinoplasty are classified by open and closed approach
- Transcartilaginous incision is also known as the intracartilaginous incision
- Transcartilaginous incision is given 3 to 5 mm caudal to the cephalic end of the lower lateral cartilage
- Infracartilaginous incision is also known as the marginal or rim incision
- Complete transfixion incision disrupts the tip support mechanism
- Most common incision in open rhinoplasty → Transcolumellar incision
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