Comparing the Alteration of Nasal Tip Sensibility and Sensory Recovery Time following Open Rhinoplasty with and without Soft Tissue Removal

In this study we evaluated sensory alteration in nasal tip and adjacent upper columella (territory of external nasal nerve) after open rhinoplasty. Two groups were randomly selected, each containing 25 patients with thick nasal skin; sensory testing was done preoperatively in all patients; in group one, subdermal soft tissue in tip and supratip areas was removed but in group two no soft tissue removal was done; we compared sensory pressure threshold values 3 weeks and 6 months postoperatively. Results showed no statistical difference between the two groups in nasal skin sensibility at these times; also this study showed that 6 months after rhinoplasty normal sensation of nasal skin will be achieved. 1. Introduction Rhinoplasty in patients with thick nasal skin is one of the most challenging operations; regardless of its cause, the thick soft tissue coverage represents a distinct limitation in rhinoplasty because the skin will usually not redrape properly over the nasal skeletal framework [1, 2]. The operative management of such a deformity is controversial and ranges from limited procedures with no soft tissue removal [1] to scoring the dermis [3] or even tip defatting [2–5]. An anatomical and histological evaluation of the tissue specimens obtained from the tip and supratip regions showed that collagenous fibrous tissue, adipose tissue, and skeletal muscle were the predominant subdermal tissue type present; fibrous tissue, in fact, comprised the majority of the subdermal tissue so this fibromuscular tissue can be safely resected without violating the dermis thereby decreasing the soft tissue bulk of the bulbous nasal tip and not interfering with the vascular supply to the skin envelope [6]. One of the complications that commonly are seen after rhinoplasty is hypesthesia; the terminal branch of the anterior ethmoidal nerve supplies tip sensation and is usually transected during intercartilaginous incision [7]. In one study 3 weeks and one year after open rhinoplasty the sensibility of various parts of the external nasal skin was evaluated and it was shown that altered sensibility following open rhinoplasty occurs in the early postoperative period (3 weeks post operatively) in the area of skin supplied by the external nasal nerve (nasal tip and adjacent upper columella); but sensation became normal after one year; the nerve is probably injured during the subcutaneous dissection as the nerve passes between the nasal bone and the upper lateral cartilage to supply the skin [8]. According to these studies we decided to evaluate sensory alteration in nasal