Hypoplastic Lateral Crus Causing Alar Retraction and Underprojected Nasal Tip: Correction with Multiple Grafts

2012 ◽  
Vol 36 (4) ◽  
pp. 862-865 ◽  
Author(s):  
Cengiz Acikel
Keyword(s):  
Lateral Crus ◽  
Nasal Tip ◽  
Alar Retraction

scholarly journals Lateral intercrural suture in the caucasian nose: Decreased domal divergence angle in endonasal rhinoplasty without delivery

2012 ◽  
Vol 16 (02) ◽  
pp. 232-235
Author(s):  
Marcos Mocelin ◽  
Caio Soares ◽  
Rogério Pasinato ◽  
Andreia Frota ◽  
Cezar Berger
Keyword(s):  
Prospective Study ◽  
Divergence Angle ◽  
Lateral Cartilage ◽  
Lower Lateral Cartilage ◽  
Lateral Crus ◽  
Basic Technique ◽  
Nasal Tip ◽  
Definition Of

Summary Introduction: Several techniques can be performed to improve nasal tip definition such as cartilage resection, tip grafts, or sutures. Objctive: To evaluate the outcome of lateral intercrural suture at the lower lateral cartilage by endonasal rhinoplasty with a basic technique without delivery in decreasing the angle of domal divergence and improving the nasal tip definition. Method: This prospective study was performed in 64 patients in which a suture was made on the board head of the lower lateral cartilage in the joint between the dome and lateral crus, using polydioxanone (PDS) with sharp, curved needle. Results: In all of the cases, better definition of the nasal tip was achieved by intercrural suturing for at least 6 months postoperatively. Conclusion: Lateral intercrural suture of the lower lateral cartilage provides improved nasal tip definition and can be performed by endonasal rhinoplasty without delivery in the Caucasian nose.

scholarly journals Cephalic lateral crural advancement flap

2021 ◽  
Vol 48 (2) ◽  
pp. 158-164
Author(s):  
Fuat Bulut
Keyword(s):  
Analogue Scale ◽  
Advancement Flap ◽  
Open Rhinoplasty ◽  
Nasal Patency ◽  
Lower Lateral Cartilage ◽  
Lateral Crus ◽  
Tip Rotation ◽  
Nasal Tip ◽  
The Mean

Background In lower lateral cartilage (LLC) surgery, cephalic trimming poses risks for the collapse of the internal and external nasal valves, pinched nose, and drooping deformity. The cephalic lateral crural advancement (CLCA) technique presented herein was aimed at using a flap to increase nasal tip rotation and support the lateral crus, in addition to the internal and external nasal valves, by avoiding grafts without performing excision.<br/>Methods This study included 32 patients (18 female and 14 male) and the follow-up period for patients having undergone primer open rhinoplasty was 12 months. The LLC was elevated from the vestibular skin using the CLCA flap. A cephalic incision was performed without cephalic trimming. Two independent flaps were formed while preserving the scroll ligament complex. The CLCA flap was advanced onto the lower lateral crus while leaving the scroll area intact. The obtained data were analyzed retrospectively.<br/>Results The mean age of the patients was 31.6 years (range, 20–51 years). The Rhinoplasty Outcome Examination scores after 12 months varied from 90 to100 points, and 93% of patients reported perfect satisfaction. At a 1-year follow-up, the patients’ nasal patency (visual analogue scale) rose from 4.56±1.53 (out of 10) to 9.0±0.65 (P<0.001).<br/>Conclusions The CLCA flap led to better nasal tip definition by protecting the scroll area, increasing tip rotation, and supporting the internal and external nasal valves without cephalic excision.

Alar Lateral Crus in Nasal Tip Surgery

1997 ◽  
Vol 21 (1) ◽  
pp. 43-47 ◽  
Author(s):  
Aldo Fontana ◽  
Egle Muti
Keyword(s):  
Lateral Crus ◽  
Nasal Tip

scholarly journals Technique for Reconstruction of Nasal Alar Defects in Asian Patients with a Modified Bilobed Nasolabial Flap

2021 ◽  
pp. 1-3
Author(s):  
Priya Tiwari ◽  
Priya Tiwari ◽  
Ong Wei Chen ◽  
TC Lim ◽  
Lim Jane
Keyword(s):  
Nasal Reconstruction ◽  
Nasolabial Fold ◽  
Nasolabial Flap ◽  
Pivot Point ◽  
Nasal Tip ◽  
Bilobed Flap ◽  
Asian Patients ◽  
Alar Retraction ◽  
The Aesthetic ◽  
Secondary Lobe

Introduction: The Oriental nose differs from the Caucasian nose in terms of size, subunit definition, texture, and thickness of the skin [1]. Zitelli’s bilobed flap enables aesthetic reconstruction in Caucasian noses but in smaller Oriental noses the outcomes are less desirable with nasal alar retraction commonly seen [2]. Hence, we describe a modification of Zitelli’s bilobed flap incorporating nasolabial skin for a single stage nasal reconstruction with reduced nasal alar retraction [3]. Methods: We modified the bilobed flap based on Zitelli’s bilobed flap and the aesthetic subunit principle, as modified for Orientals by Yotsuyanagi in 2000 [4]. The primary lobe was located between the defect and the cheek and the second lobe was located on the cheek, above the nasolabial fold. The modification of the bilobed flap was designed to have a primary lobe that was 10% longer than the length of the distal defect edge from the flap’s pivot point, and the width of the primary lobe was equal to the width of the defect. The length of the secondary lobe was 130% of the length of the distal defect edge to the flap’s pivot point, and the width of the secondary lobe was two-thirds the width of the primary lobe. Results: Satisfactory alar reconstruction was achieved from the viewpoint of the patient and surgeon. There was good nasal contour and appropriate symmetry of the nasal tip with reduced nasal alar retraction. Conclusion: The modification of Zitelli’s bilobed flap to have a longer primary lobe and include nasolabial skin, results in reduced nasal alar retraction.

Hemitransdomal versus Dome-Binding Suture

2017 ◽  
Vol 34 (01) ◽  
pp. 102-106 ◽  
Author(s):  
Fernando Casanueva ◽  
Felipe Cardemil ◽  
Deniz Gerecci
Keyword(s):  
Surgical Training ◽  
Rotational Axis ◽  
Open Rhinoplasty ◽  
Training Center ◽  
Objective Data ◽  
Lateral Crus ◽  
Nasal Tip ◽  
Significant Difference ◽  
Oregon Health ◽  
Suture Placement

AbstractThe dome-binding suture (DBS) and hemitransdomal suture (HTS) are suture techniques used to narrow and define the nasal tip. The DBS can create a pinched, unnatural appearance, while the HTS puts the lateral crus in a more favorable orientation. This allows a natural contour between the nasal tip and alar lobule while maintaining alar margin support. Objective measurement of the rotational axis of the lateral crus between the DBS and the HTS has not been reported in the literature. To determine whether the DBS or HTS technique results in a more favorable rotational axis of the lateral crus as measured by the alar surface septal angle (ASSA). Open rhinoplasty with cephalic trim and placement of a DBS or HTS was performed in 6 cadaveric heads, for a total of 12 lower lateral cartilages at the VirtuOHSU Simulation and Surgical Training Center at Oregon Health and Science University (OHSU). ASSA measurements were taken at baseline and after placement of either a DBS or HTS. A total of 36 ASSA measurements were obtained. The median baseline ASSA prior to suture placement was 142 degrees (interquartile range [IQR]: 131.5–145 degrees), following DBS placement was 141 degrees (IQR: 33–150.5 degrees), and following HTS placement was 112 degrees (IQR: 108–117 degrees). There was no statistically significant difference of ASSA measurements between baseline and DBS placement (p = 0.24), but there was a statistically significant difference between baseline and HTS (p < 0.0001) and between DBS and HTS (p < 0.0001). The HTS technique creates a more favorable rotational axis of the lateral crus as compared with the DBS, as measured by the ASSA. This study provides objective data to support the use of the HTS for nasal tip contouring.

Preventing Alar Retraction by Preservation of the Lateral Crus

2010 ◽  
Vol 126 (2) ◽  
pp. 581-588 ◽  
Author(s):  
Ronald P. Gruber ◽  
Andrew Zang ◽  
Khashayar Mohebali
Keyword(s):  
Lateral Crus ◽  
Alar Retraction

The Isis Cruraplasty

1998 ◽  
Vol 15 (2) ◽  
pp. 137-141
Author(s):  
Steven Burres
Keyword(s):  
Surface Area ◽  
Lateral Cartilage ◽  
Lower Lateral Cartilage ◽  
Lateral Crus ◽  
Nasal Tip ◽  
Natural Configuration ◽  
Lateral Segment ◽  
Columellar Strut ◽  
Bulbous Nasal Tip ◽  
Tip Formation

Most of the reshaping techniques for a blunt, bulbous nasal tip reduce the curvature and surface area of tip lobule cartilage, and they reform the tip to add definition. Unfortunately, the assemblage of surgical maneuvers frequently reduces valued projection, and it may result in an unnatural tip formation with a distasteful pattern of contracture. Employing the Isis cruraplasty allows incremental tip enhancement and narrowing, while restoring or preserving the natural configuration. After lateral dome division and undermining of the medial portion of the lateral crus, the lateral segment of the lateral crus was transected incrementally and advanced to reenforce the deficiency in rim support. Sewing the medial flanges together created a cartilaginous platform that supported the Isis graft, and/or it accommodated a columellar strut, if indicated. The Isis cruraplasty conserves virtually all of the lower lateral cartilage without compromising the potential for tip reshaping and augmentation.

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