Cephalic lateral crural advancement flap

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.

Costal Cartilage Lateral Crural Strut Graft for Correction of External Nasal Valve Dysfunction in Primary and Revision Rhinoplasty

Objective: To evaluate and compare the costal cartilage lateral crural strut graft’s (LCSG) ability to support a weak lateral crus in patients with external nasal valve dysfunction (EVD) undergoing primary versus revision functional rhinoplasty. Methods: This is a prospective cohort study of 26 patients (mean [SD]: 40.23 [6.75] years of age; 10 [38%] females) with clinically diagnosed EVD, who underwent primary versus revision functional rhinoplasty with the use of a costal cartilage LCSG (10 [38%] primary functional rhinoplasty patients and the 16 [62%] revision patients). Preoperative and 12-month postoperative subjective and objective functional measurements along with statistical analysis were performed. Results: While all baseline demographic and preoperative functional measurement scores were similar between the 2 groups, the primary cohort’s preoperative scores were higher overall. Follow-up was a mean of 14.58 months. The primary group demonstrated a greater difference in score improvement postoperatively in all categories. All patients had significantly improved visual analog scale (VAS), Nasal Obstruction Symptom Evaluation Scale, 22-Item Sinonasal Outcome Test, and nasal peak inspiratory flow (NPIF) scores. When comparing the overall score outcome and surgical efficacy of the LCSG, both groups had near equal final score outcomes with the exception of VASL and NPIF. Conclusion: The LCSG is a viable and versatile option in the management of EVD for both primary and revision rhinoplasty patients.

Sonoelastographic Evaluation of the Lower Lateral Nasal Cartilage Lateral Crus, Auricular Conchal Cartilage, and Costal Cartilage

We investigated the sonoelastographic features of the lower lateral nasal cartilage lateral crus (LLNC-LC), auricular conchal cartilage (ACC), and costal cartilage (CC). In this prospective study, group 1 consisted of 60 participants (30 males and 30 females) between 18 and 35 years of age. Group 2 consisted of 60 participants (30 males and 30 females) between 35 and 50 years of age. Strain elastography (SE) and shear wave elastography (SWE) were performed. For all LLNC-LCs and ACCs, type I SE was detected more in group 2, type II SE was detected more in group 1, and type III SE was detected more in group 1 (p < 0.05). For CC, type I SE was detected more in both groups (p < 0.05). For LLNC-LC, type I SE was detected more in males compared with females in both groups (p < 0.05). For all LLNC-LC, ACC and CC, the SWE modulus of group 2 was significantly higher than that of group 1 (p < 0.05). In older participants, the SWE modulus increased. We recommend using ACC mainly in rhinoplasty operations for primary and revision cases as its SWE modulus is similar to that of the LLNC-LC. However, due to the higher SWE modulus of CC, CC grafts should not be used as the first choice in rhinoplasties, especially in the reconstruction of the nasal tip contour, but may be used in nasal dorsum augmentation.

Research on Macroanatomic and Histologic Characteristics of the Lower Lateral Nasal Cartilages in Vietnamese

BACKGROUND: There are recently many studies about the anatomy of lower lateral cartilage (LLC). However, the microanatomic studies to identify the segments of most LLC at the nasal tip in Vietnamese are very rare. AIM: Investigate the macroanatomic and microanatomic characteristics of the LLC and the structures of the nasal tip. METHODS: Descriptive study, 30 cadaver noses fixed by 10% formalin, 2 cadaver noses fixed by HE in 69 Institutes in Vietnam from December 2017 to April 2019. RESULTS: The average length of the medial crus is 12.3 mm on the right and 13.2 mm on the left. The maximum intercrural distance is 10.7 mm. The average length of the dome is 3.7 mm and 3.9 mm on the right and left side separately, with 2 subunits are the domal and lobular segment. The average thickness of the tip points is 1.0 mm. The width of the interdomal and intercrural ligaments are 0.5-fold the height and 2-fold the thickness. The thickness of the interdomal fat pad is 3mm and about 0.5-fold the wide. CONCLUSION: The LLC has 3 parts: intermediate, medial and lateral crus. The microanatomic structures of tip consist of the interdomal ligaments, intercrural ligaments, SMAS and interdomal fat pad.

Hemitransdomal versus Dome-Binding Suture

The 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.

Management of the Cephalically Malpositioned Lower Lateral Crus in Aesthetic Rhinoplasty

Cephalic malposition of the lower lateral cartilages (LLC) gained increasing awareness as a distinct anatomical entity within the last years. It has become clear that this type of deformity is not amenable to traditional rhinoplasty techniques. Repositioning of the lateral crus of the LLC enables the surgeon to achieve significant and reliable changes in the shape and function of the nose. The authors present their technique for repositioning of the cephalically malpositioned LLC. Their method is based on a turn-in flap that is positioned along the caudal margin of the repositioned LLC. This flap straightens a convex LLC and gives reliable structural support to the caudal alar margin. In this article, they discuss the various indications of this technique, introduce a new, more precise concept for evaluation of the axis of the lateral crus of the LLC, and highlight additional details of this reliable technique.