FOOTPLATES OF THE MEDIAL CRURA

The purpose of this combined prospective and retrospective study was t o review the abnormalities of the footplates of the medial crura, thei r surgical correction, and the dynamic changes that result from footpl ate alteration. Prospectively, measurements of 40 footplates were obta ined during 20 consecutive primary rhinoplasties. The distance between the footplates at their most posterocaudal position was measured, alo ng with the thickness, length, and width of the footplates. The shape of the nostrils was also observed and correlated to the form of the fo otplates. The distance between the footplates ranged from 7.5 to 15 mm , the average being 11.4 mm. The length of the footplates ranged from 4 to 7.5 mm, the average being 5.81 mm. The thickness of the footplate s averaged 1.06 mm, ranging from 0.80 to 1.5 mm. The width of the foot plates ranged from 2.5 to 7.0 mm, averaging 4.48 mm. In a retrospectiv e review of 295 consecutive rhinoplasties, footplates were altered in 76 cases (25.8 percent). Of these cases, 29 procedures (9.8 percent) w ere performed to narrow the columella base and to advance the subnasal e: on 24 patients (8.1 percent), the goal of this maneuver was to narr ow the columella base only; on 5 patients (1.7 percent), the operation was conducted to aid in increasing the tip projection, provide a bett er foundation for the tip, advance the subnasale caudally, and narrow the alar base. Asymmetry of the columella was corrected in 16 patients (5.4 percent), and footplates were resected primarily to reduce the t ip projection in 2 patients (0.7 percent). A detailed analysis of the nasal base will dictate one of the following courses pertaining to foo tplate alteration. If the patient exhibits an overprojected tip and di vergent footplates, the lateral portion of the footplates will be rese cted partially, then approximated. If the tip is under-projected or ha s normal projection, the divergent footplates will be approximated wit hout resection. Should the subnasale and the base of tile columella be protruding, the soft tissue between the footplates will be removed to avoid excess fullness in this site as a result of the approximation o f the footplate. However, when the footplates are divergent, the colum ella base and nasal spine area are often retracted, setting an auspici ous stage for approximation of the footplates without having to excise the soft tissue. This maneuver not only narrows the columella base, i t also advances it caudally. Longstanding caudal deviation of the sept um may also create asymmetry of tile footplates, which will not respon d to mere repositioning of the septum, and often requires repositionin g of the footplates with mobilization and fixation to the contralatera l footplates.