By Larry M. Wolford, DMD, Carlos A. Morales-Ryan, DDS, MSD
Dr. Larry Wolford has used the transverse columellar suture technique to improve the functional and esthetic factors associated with a wide columella base. The procedure can be used as an isolated procedure or in conjunction with orthognathic surgery and/or rhinoplasty.
Statement of the Problem
A functional and esthetic aspect affecting the nose that is often ignored, involves the presence of a wide columellar base. In this condition the feet of the middle crura are flared laterally, with interpositional connective tissue. Functionally, this can cause constricture of the transverse width of the nares, which can create airway inadequacy at the nares. From an esthetic standpoint, a wide columella base gives the nose a more masculine look. A simple suture technique can be used to correct the functional and esthetic problems created by this anatomical variance. Orthognathic surgery generally has little effect on this area. However, advancement or superior repositioning of the maxilla may cause some increased width to the columella base.
Transverse Columellar Suture Technique Description
Upon completion of all other surgical procedures, the transverse columella suture can be placed. An intranasal incision approximately 3 mm in length is made 3 to 4 mm inside the nostril sil at the base of the nostril, directly over the alar foot, being careful not to incise through the underlying cartilage. The same incision is made on the opposite side. A clear 4-0 nylon or prolene suture is used on a straight needle or a straightened curved needle, and passed through one incision at the base of the foot transversely through the columella and out through the alar foot and incision on the opposite side. In a mattress fashion, the suture is passed back through the same incision, through the columella and out the original incision. The suture is then tightened to the desired width and tied. A second suture can be passed in a similar fashion to ensure good stability. The incisions can be closed with one to two 5-0 or 6-0 chromic sutures, if desired. The senior author usually does not close the incision, but allows them to heal on their own. The potential risks and complications include: 1) Breaking of the suture or incising through the cartilage of the alar base; resulting in no improvement, functionally or esthetically; 2) Infection; 3)Exposure of the suture post surgically; 4)Asymmetry, if both feet are not incorporated in the suture.
Summary of Dr. Wolford's Personal Experience
In the 12 years that this technique has been routinely used, there have been no known complications associated with the use of this technique. The procedure can be used as an isolated procedure or in conjunction with orthognathic surgery and/or rhinoplasty. The transverse columellar suture is a simple technique to improve the functional and esthetic factors associated with a wide columella base.