Invited Discussion on: Posterior Cephalic Soft Triangle of the Nose: Surgical Implications
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EDITOR’S INVITED COMMENTARY
Invited Discussion on: Posterior Cephalic Soft Triangle of the Nose: Surgical Implications Nuri A. Celik1
Received: 21 October 2020 / Accepted: 21 October 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020
Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 The authors bring a new insight to the topic of external valve insufficiency [1]. They define a new anatomic subunit of the external nasal valve. This involves the area between the lower lateral cartilage, upper lateral cartilage and the distal nasal bone, forming the posterior cephalic soft triangle (PCST). This anatomic segment overlies the pyriform ligament. There is a detailed description of this specific anatomic unit of the posterior cephalic soft triangle and its functional correlations. Their evaluation shows this area to be an important component of the external nasal valve, possibly the weakest. The authors present their approach for the management of the problems associated with the posterior cephalic soft triangle of the nose in this retrospective study paper. Their data are mostly descriptive and clinical rather than quantitative. The schematic and clinical pictures are self-explanatory. The authors use ultrasonic rhinoplasty that requires a wider dissection in this area that enabled them to observe the anatomical problems more clearly. During open approach rhinoplasty in a two-year period, they detected twenty-four cases in which the PCST was either weak or deformed and developed surgical techniques to overcome the structural and functional issues. They should be congratulated for their systematic evaluation of the anatomical and functional components of breathing
& Nuri A. Celik [email protected] 1
Private Practice, Istanbul, Turkey
issues related to this tiny specific anatomical zone. They found the most common pathology in the PCST was overresection of the posterior segments of LLC’s during primary surgery. En bloc medialization of the PCST is the second in frequency. Their treatment consisted of triangular on-lay grafting of the PCST and lateralization of the caudal edge of the nasal bone. They present excellent results of their technique. The external nasal valve area is a controversial subject. Constantian and Martin think this lack of consensus is hindering rhinoplasty education [2]. Some authors refer to the external valve as a volume [3]. The internal and external nasal valves are distinct anatomic areas; though there is no consensus on their boundaries, they share a common border at the scroll. Some authors refer to the PCST zone as a part of the internal nasal valve [4]. It is well documented in the literature that reduction techniques play a major role in unsatisfactory results following a rhinoplasty. The reductio
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