Sublabial approach for columellar reconstruction in corrective rhinoplasty

Abstract

Columellar reconstruction is a challenging endeavour, both functionally and aesthetically. The aim of this study is to present a novel technique for columellar reconstruction via the sublabial approach. Thirty-two patients (21 men, 11 women, mean age 33.8) with columellar collapse underwent columellar reconstruction via the sublabial approach. Following an upper gingivo-buccal sulcus incision, a tunnel was created through which a cartilage graft, preferably septal, was introduced and fixed. An additional crescent-shaped graft was introduced to secure the fixed graft into position. Average operating time was 35 min for septal grafts, and 55 min for conchal grafts. The mean duration of follow up was 21 months. Postoperative complications included graft absorption in two cases (6.25%), graft extrusions in two cases (6.25%), and postoperative infection in one case (3.12%). These complications were encountered at the beginning of our learning curve. Following technical modifications, these complications were virtually eliminated. Precise control on recipient pocket dimensions, proper graft fixation and avoidance of graft visibility are strongly recommended. In conclusion, columellar reconstruction via the sublabial approach is an anatomic, minimally invasive, time-saving procedure. The operative technique is easy to perform and can be rapidly mastered. It provides structural support, shape, height, and projection to the tip lobule, and the resultant scar is cosmetically superior. It is particularly advantageous in cases of previous septal operations and septal perforation.