What is causing the clicking problem? Is it my columella strut?

Question

I have been having clicking problems with my columella strut and my surgeon came to a final conclusion after 6 months post op that is is slightly too long. one thing I dont understand is that when I move my upper lip I feel it moving around and if I push my finger where I feel it, it moves around, as if you can play with it if you will. I dont understand, if it goes into a pocket why is it freely floating and moving around? does it relate back to it being too long? I would like to understand

Gerald Minniti, MD, FACS · Answer

Hello,The columellar strut is an 'interposition' graft that is sutured between the two medial crura of the tip cartilages, which occupy the portion of the nose called the columella.  This part of your nose is not securely fastened to any non-moving, stable parts of your nose or face like septum or maxillary bone. Instead it glides around, and that is why most people can move the tip of their nose forward and back.Your graft, if too long or if not properly secured between your medial crura will 'catch' the edge of the septum, making that clicking sound/feeling. Either trimming the exposed portion of graft, restitching it so that it isn't so protuberant, or tightening the membranous septum so that it is less mobile will likely lesson the possibility of future clicking. I hope that this made sense!Best of luck!

Nima Shemirani, MD · Answer

Dear apple1937,The C-strut can move around, even if we place it in a pocketThe pocket is a soft tissue pocket so the C-strut can still be mobile (it is like moving around your skin)Trimming the point of contact can help, or securing it to the septum can help tooYou just have to be careful because moving the C-strut can also affect tip positionIt sounds like your surgeon has it handled and will take care of it appropriatelyBest,Dr. Nima

Eric M. Joseph, MD · Answer

We place a columellar shoring strut in nearly all of our rhinoplasty patients to maintain tip support, and sometimes to aid in tip projection and rotation. C-struts are typically placed in a pocket between the medial crura, and are suture fixated. If you move your columella with your thumb and index finger and notice clicking, there may be a relatively simple remedy. We have had success dealing with occasional clicking C-struts by trimming the bottom of them where they may be rubbing against bone. The approach may be through a small incision between your upper lip and gum, and there is typically fast recovery and little, if any, downtime.Hope this helps, and wishing you well.Dr Joseph.

Mohsen Tavoussi, MD, DO · Answer

Recommend no manipulation of your nose and see your surgeon for evaluation. There are a number of procedures that can be performed on the nose which may include cartilage grafting which may feel mobile if is placed at the nasolabial angle.

Richard J. Brown, MD · Answer

You have to understand. Cartilage is flexible. It moves. Just because it is in a pocket does not mean it will stay completely still. Sure it could be too long. I have never examined you so I would not know but just answering your question you have to understand cartilage can move especially in the area of the columella because the tip of the nose is all cartilage and soft tissue, no bone.

What is causing the clicking problem? Is it my columella strut?

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Answer: Post op rhinoplasty

Answer: Post op rhinoplasty

Answer: What is causing the clicking problem? Is it my columella strut?

Answer: What is causing the clicking problem? Is it my columella strut?

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What is causing the clicking problem? Is it my columella strut?

Answers (7)

Answer: Post op rhinoplasty

Answer: Post op rhinoplasty

Answer: What is causing the clicking problem? Is it my columella strut?

Answer: What is causing the clicking problem? Is it my columella strut?

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Everything you need to know about Rhinoplasty

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