Footplates of the medial crura.

The purpose of this combined prospective and retrospective study was to review the abnormalities of the footplates of the medial crura, their surgical correction, and the dynamic changes that result from footplate alteration. Prospectively, measurements of 40 footplates were obtained during 20 consecutive primary rhinoplasties. The distance between the footplates at their most posterocaudal position was measured, along with the thickness, length, and width of the footplates. The shape of the nostrils was also observed and correlated to the form of the footplates. 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 footplates averaged 1.06 mm, ranging from 0.80 to 1.5 mm. The width of the footplates ranged from 2.5 to 7.0 mm, averaging 4.48 mm. In a retrospective review of 295 consecutive rhinoplasties, footplates were altered in 76 cases (25.8 percent). Of these cases, 29 procedures (9.8 percent) were performed to narrow the columella base and to advance the subnasale: on 24 patients (8.1 percent), the goal of this maneuver was to narrow the columella base only; on 5 patients (1.7 percent), the operation was conducted to aid in increasing the tip projection, provide a better 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 tip projection in 2 patients (0.7 percent). A detailed analysis of the nasal base will dictate one of the following courses pertaining to footplate alteration. If the patient exhibits an overprojected tip and divergent footplates, the lateral portion of the footplates will be resected partially, then approximated. If the tip is underprojected or has normal projection, the divergent footplates will be approximated without resection. Should the subnasale and the base of the 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 of the footplate. However, when the footplates are divergent, the columella base and nasal spine area are often retracted, setting an auspicious stage for approximation of the footplates without having to excise the soft tissue. This maneuver not only narrows the columella base, it also advances it caudally. Longstanding caudal deviation of the septum may also create asymmetry of the footplates, which will not respond to mere repositioning of the septum, and often requires repositioning of the footplates with mobilization and fixation to the contralateral footplates.