Objectives: The Cartilaginous Push Down for the nasal hump treatment as described by Jorge Ishida in 1999 has been modified throughout the past decades, here we show the main modifications and current indications of this technique.
Introduction: The nasal hump reduction based on the partial resection of the cartilages and bones of the nose, as it was described by Joseph more than a century ago, may lead to dorsum deformities as inverted “V”, irregularities and open roof. The nasal dorsum preservation techniques like the Push Down and Let Down avoid these problems. The problem is that these techniques are more difficult to be applied to large, broad or deviated noses. The Cartilaginous Push Down on the other hand, is indicated as well in those large and deviated humps.
Materials / method: We studied 595 patients that had their humps treated with cartilaginous push down during the past 10 years and 48 patients treated with a major modification of this technique (preservation of the bony cap) over the last 1,5 year.
Results: The Cartilaginous Push down has a much ample indications when compared to the preservation techniques as the Cottle's Push down and Let down.
Conclusion: The preservation approach for the hump treatment has several advantages over the classic hump treatment. It preserves the internal valve function, the smoothness of the dorsum and the nasal dorsum aesthetic lines. The cartilaginous push down widens the indications of the preservation techniques allowing the treatment of larger, deviated and/or high angled humps. The addition of the bony cap to the cartilaginous push down preserves the external portion of the keystone area, thus adding a smooth osteo- cartilaginous transition similarly to the push/let down techniques.
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