In their discussion of Kalantar-Hormozi and Beiraghi-Toosi’s article on smile analysis in rhinoplasty, Ahmad and Rohrich have raised the conundrum of the depressor septi nasalis.1,2 The discussants state that the origin of the depressor septi nasalis is the medial crural footplates. They cite the original work of Rohrich et al.,3 which describes three types of depressor septi nasalis whose insertion varies: type I, interdigitating with the orbicularis oris muscle (62 percent); type II, onto the periosteum (22 percent); and type III, rudimentary or not present (16 percent). The conundrum is that virtually all other surgical anatomists4–10 consider the origin of the depressor septi nasalis to be the maxilla just above the lateral incisor and its insertion to be the anterior nasal spine, medial crura footplates, and a continuation into the membranous septum. Why the discrepancy and how to resolve it?
In a previous article,4 we emphasized that the plane of dissection can influence one’s interpretation of the depressor septi nasalis—a top-down dissection from the skin tends to indicate a more superficial labial course for the muscle, whereas a bottom-up gingival dissection reveals the bony origin. Because the only article that assigns the origin of the depressor septi nasalis to the medial crura footplates and its insertion into the lip is that of Rohrich et al.,3 perhaps they could resolve the conundrum. They could repeat their original study with two modifications. First, the dissections would be performed on fresh cadavers, not fresh frozen cadavers with their storage distortions. Second, a bottom-up gingival approach could be used, which is similar to that of their surgical procedure. Obviously, it makes sense to conduct the anatomical studies through the same incision as the preferred operative incision. Certainly, the time has come for rhinoplasty surgeons to resolve the conundrum of the origin and insertion of the depressor septi nasalis.
The author has no financial interest to declare in relation to the content of this communication.
Rollin K. Daniel, M.D.
1441 Avocado Avenue, Suite 308
Newport Beach, Calif. 92660-7721
1. Kalantar-Hormozi A, Beiraghi-Toosi A. Smile analysis in rhinoplasty: A randomized study for comparing resection and transposition of the depressor septi nasi muscle. Plast Reconstr Surg. 2014;133:261–268
2. Ahmad J, Rohrich RJ. Discussion: Smile analysis in rhinoplasty: A randomized study for comparing resection and transposition of the depressor septi nasi muscle. Plast Reconstr Surg. 2014;133:269–271
3. Rohrich RJ, Huynh B, Muzaffar AR, Adams WP Jr, Robinson JB Jr. Importance of the depressor septi nasi muscle in rhinoplasty: Anatomic study and clinical application. Plast Reconstr Surg. 2000;105:376–383; discussion 384
4. Daniel RK, Glasz T, Molnar G, Palhazi P, Saban Y, Journel B. The lower nasal base: An anatomical study. Aesthet Surg J. 2013;33:222–232
5. de Souza Pinto EB. Relationship between tip nasal muscles and the short upper lip. Aesthetic Plast Surg. 2003;27:381–387
6. DeSouza Pinto EB, Rocah RP, Filho WQ, et al. Anatomy of the median part of the septum depressor muscle in aesthetic surgery. Aesthetic Plast Surg. 1998;22:111–115
7. Letourneau A, Daniel RK. The superficial musculoaponeurotic system of the nose. Plast Reconstr Surg. 1988;82:48–57
8. Saban Y, Polselli R Atlas d’Anatomie Chrirurgicale de la Face et du Cou. 2009 Firenze, Italy SEE Editrice
9. Saban Y, Andretto Amodeo C, Hammou JC, Polselli R. An anatomical study of the nasal superficial musculoaponeurotic system: Surgical applications in rhinoplasty. Arch Facial Plast Surg. 2008;10:109–115
10. Kosins AM, Lambros V, Daniel RK. The plunging tip: Illusion and reality. Aesthet Surg J. 2014;34:45–55
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