The Nasal Hinge

1994 ◽  
Vol 111 (3P1) ◽  
pp. 219-231 ◽  
Author(s):  
Peter A. Adamson ◽  
Todd A. Morrow
Keyword(s):  
Clinical Results ◽  
Plastic Surgeon ◽  
Hinge Region ◽  
Lateral Cartilage ◽  
Lower Lateral Cartilage ◽  
Lateral Aspect ◽  
Nasal Tip ◽  
Tip Projection ◽  
Facial Plastic

It is generally agreed that rhinoplasty is the most challenging procedure performed by the facial plastic surgeon. Mastery of nasal tip maneuvers to alter tip projection, rotation, and lobule refinement is intrinsic to successful rhinoplasty technique. The nasal hinge region comprises the most lateral aspect of the lower lateral cartilage. Its importance is often overlooked. As the foundation of the nasal base, It plays a key role in tip dynamics and can be sculpted to significantly modify projection, rotation, and lobule refinement. One hundred randomly selected rhinoplasty patients were studied with respect to the indications for hinge maneuvers, techniques applied, and resulting affect on tip aesthetics. Clinical results are shown. The applicability of these hinge techniques is compared with other lateral crural techniques. The importance of the hinge region in rhinoplasty dynamics and the necessity of knowledgeably applying surgical maneuvers in this region are discussed.

Median Horizontal Split Tip

1985 ◽  
Vol 93 (1) ◽  
pp. 35-40 ◽  
Author(s):  
Frank M. Kamer ◽  
Alfred Cohen
Keyword(s):  
Lateral Cartilage ◽  
Lower Lateral Cartilage ◽  
Horizontal Strip ◽  
Tip Rotation ◽  
Nasal Tip ◽  
Tip Projection ◽  
Innovative Technique ◽  
Central Strip ◽  
Nasal Tip Projection

One of the most difficult problems encountered in rhinoplasty is lack of nasal tip projection. An innovative technique is described that utilizes the removal of a median horizontal strip of lower lateral cartilage to enhance projection, while maintaining a natural highlight and tip support without the use of grafts. The indications are limited to noses that have a widened dome requiring removal of a central strip, and tip rotation. Alternate techniques are discussed; cases and results are discussed.

Correction of the Overprojected Nasal Tip

1994 ◽  
Vol 11 (3) ◽  
pp. 195-202
Author(s):  
Andrew P. Ordon
Keyword(s):  
Soft Tissue ◽  
Nasal Septum ◽  
Lateral Cartilage ◽  
Lower Lateral Cartilage ◽  
Nasal Tip ◽  
Tip Projection ◽  
Medial Crura ◽  
Final Adjustment ◽  
Moderate Case

Our approach to decrease tip projection is presented. These techniques may be applied to the three degrees of overprojection, namely the relative, moderate, and ultraprojecting tip. We feel that our techniques will apply to all clinical situations where decrease in projection is desirable. Our concepts have emerged from review of previous techniques and have evolved over our past 1000 rhinoplasties. Excess nasal septum including the nasal spine area, redundancy in the feet of the medial crura, and soft tissue excess may all contribute to the overprojecting tip. However it is excess in the lower lateral cartilage complex, specifically in the medial crus, that requires the most surgical attention and alteration. Our technique in reducing the medial crus to decrease projection is patterned after the Universal Tip Technique described by Parkes and Kanodia. This endonasal technique utilizes a laterally based unipedicled lower lateral cartilage flap, which is freely rotational, but does not violate the continuity of the vestibular skin. With development of our laterally based unipedicle lower lateral cartilage flap, the number of millimeters desired to reduce the projection is removed from the medial crus and eliminated in the final adjustment of tip projection and, in this way, decreases tip projection. In the moderate case, approximately 3 mm of medial crus is excised. In the more severe or ultraprojecting tip, ≥5 is removed from the medial crus. In extreme overprojecting noses, excess soft tissue is addressed by excision of an ellipse of mucosa at the intercartilaginous incision at the septal angle. In the ultraprojecting tip, in addition to resection of redundant cephalic lower lateral cartilage and a ≥5-mm segment of medial crus, it may be necessary to also resect the lateralmost extension of the lower lateral cartilage, the feet of the medial crura, and alar bases. Septal modification, including an inferior strip resection of septum including the nasal spine, may also contribute to decreasing projection. We have found this technique to be effective and predictable over the last 10 years.

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.

Use of Auricular Cartilage for Reconstruction of Cartilaginous Defects of the Nose: Emphasis on Reconstruction of the Lower Lateral Cartilage Complex

1994 ◽  
Vol 11 (3) ◽  
pp. 209-216
Author(s):  
John Andrew Bartlett ◽  
Peter A. Hilger
Keyword(s):  
Senior Author ◽  
Congenital Defects ◽  
Lateral Cartilage ◽  
Lower Lateral Cartilage ◽  
Fellowship Program ◽  
Previous Surgery ◽  
The Past ◽  
Facial Plastic ◽  
Case Presentations ◽  
Innovative Techniques

During a year of fellowship with Dr. R. C. Webster, a preceptor with the American Academy of Facial Plastic and Reconstructive Surgery Fellowship Program, the senior author was introduced to innovative techniques utilizing conchal cartilage to repair various defects of the nasal tip. In the past 15 years of practice, we have modified his technique slightly but many of his basic concepts and principles remain. We have replaced the entire lower lateral cartilage complex as well as segmental defects of the nose. The presentation will review techniques for reconstruction of the entire lower lateral cartilage complex, as well as segmental defects due to trauma, previous surgery, congenital defects and defects secondary to oncologic resection. Preoperative and postoperative case presentations will highlight salient surgical principles.

The Deviated Nasal Tip: A Personal Technique for Correction Using Monolateral Crural Overlay and Monolateral Dome Truncation

2021 ◽  
Author(s):  
Tito M. Marianetti ◽  
Valentino Vellone ◽  
Valerio Ramieri ◽  
Francesca De Angelis
Keyword(s):  
Treatment Strategies ◽  
Lateral Cartilage ◽  
Lower Lateral Cartilage ◽  
Self Assessment ◽  
Nasal Tip ◽  
Novel Approach ◽  
High Satisfaction ◽  
Feasible Option ◽  
The Mean

Abstract Background To present a novel approach to correct nasal tip deviation with monolateral crural overlay or monolateral dome truncation, presenting as an isolated deformity or in complex nose deviations. Nasal tip deviation can be congenital or posttraumatic, due to a dislocated septum or cartilaginous septal or lower lateral cartilage malformations. Although some treatment strategies have been introduced, appropriate treatment remains a challenge because of the complexity and variability of such deformities. Methods It had been assumed that in most nasal tip deviations, a lower lateral cartilage was longer than the contralateral one. The authors analyzed 158 patients from January 2015 to October 2019 with nasal tip deviation and corrected the deviated tip by using a monolateral interruptive technique (lateral crural overlay or monolateral dome truncation) on the lower lateral cartilage. Photographic comparison between preoperative and at least 1-year follow-up for nasal axis deviation variable was analyzed and a self-assessment questionnaire was administrated to the patients at 1-year follow-up. Results The mean nasal deviation was 6.59° (±3.1°) preoperatively and 1.56° (±0.26°) postoperatively (p < 0.05). The range of differences between pre and postoperative deviations was 2.7° to 15.1°, and the mean difference was 6.1° (±3.21°). Of the 84 patients, 47 (55.95%) were very satisfied, 33 (39.28%) were satisfied, and 4 (4.76%) were unsatisfied with surgical the results and required revision surgery. Conclusions In authors' hands, monolateral interruptive techniques (lateral crural overlay or monolateral dome truncation) are a viable and feasible option to restore nasal tip symmetry. These techniques achieved high satisfaction rates among patients and resulted in reliable and reproducible symmetry immediately visible after surgery and stable over time (1-year postsurgery controls).

scholarly journals The Stabilization of Lower Lateral Cartilage in Rhinoplasty: A New Control Suture Technique.

2020 ◽  
pp. 1-6
Keyword(s):  
Good Alternative ◽  
Suture Technique ◽  
Lateral Cartilage ◽  
Lower Lateral Cartilage ◽  
Normal Position ◽  
Nasal Tip ◽  
Primary Rhinoplasty

Abstract Objective: Reposition of malpositioned lateral crura to normal position in rhinoplasty is important both functionally and aesthetically. The aim of this study is to describe a lateral cruras reposition suture technique for supplying tip symmetry and avoiding crural displacement. Patient and Method: Sixteen primary rhinoplasty cases with malpositioned lateral crura underwent lateral crural control suture (LCCS) were reported. In this technique dissected and released lateral crura were fixed to cheek skin with a suture. Those cases were assessed with FACE-Q rhinology module both aesthetically and functionally. Result: Intraoperative or postoperative lateral crural displacement can be prevented and nasal tip symmetry can be supplied easily with LCCS. Results were satisfactory both functionally and aesthetically. Conclusion: LCCS is a good alternative to correct lateral crural malposition and obtain a tip symmetry.

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