Assessment of Nasal Function After Tip Surgery With a Cephalic Hinged Flap of the Lateral Crura: A Randomized Clinical Trial (original) (raw)
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Aesthetic Plastic Surgery, 2010
Background The term ''bulbous nose'' is used to describe a large or boxy nasal tip. Typically, correction of the bulbous tip has been achieved through a variety of cartilagemodifying maneuvers based on incision or excision of the lower lateral cartilage. Methods Horizontal reduction with a cephalic hinged flap of the lateral crura was used for 28 patients during open rhinoplasty. Effort was made to preserve the structural integrity of alar cartilage as much as possible with this technique. Results The average follow-up period was 14 months. Satisfactory results were achieved. External nasal valve collapse and pinch deformity were not observed during the postoperative period. Conclusions The described technique improves nasal tip reduction while maintaining nasal tip support and strength. The hinged flap used with this technique can both prevent weakness of the lateral crura and support it.
The Importance of Maintaining the Structural Integrity of the Lateral Crus in Tip Rhinoplasty
Aesthetic Plastic Surgery, 2009
Background A novel technique for maintaining nasal tip support and external nasal valve integrity is proposed. The procedure involves mobilizing the lateral crus to a more cranial position after altering its shape from convexity to a more flat shape. Methods With the described technique, the lower lateral cartilage is dissected free from the skin in a retrograde fashion after an intercartilaginous incision. The ligament between the lateral crus and the upper lateral cartilage is cut. The vestibular mucosa is not freed. With this maneuver, the lateral crus usually flattens sufficiently. When the convexity flattens, an extra millimeter of cartilage at the cephalic end is gained in the horizontal dimension. When the cut vestibular mucosa is sutured back to its place, the cephalic end of the lateral crus is advanced over the upper lateral cartilage. This technique allows durable support to maintain patency of the nasal valve. No bridges are burned because no cartilage is excised. The surgeon is left with the flexibility to modify the result on the operating table.
Anatomical Study of the Medial Crura and the Effect on Nasal Tip Projection in Open Rhinoplasty
Plastic and Reconstructive Surgery, 2013
Background: Common variations in morphology of the medial crura have been described. The authors' observation is that changes in nasal tip projection depend on the shape and strength of the medial crura. The authors investigated how differences in medial crura shape affect tip projection after surgical intervention. Methods: Seventeen cadaver heads were dissected with an open rhinoplasty approach. Nasal tip projection and columellar length and width were measured. Medial crura shape was noted and classified. Anthropometric measurements were made preoperatively and after each of the following procedures: (1) elevation of skin envelope and closure of the columellar incision, (2) interdomal and medial crural sutures, and (3) placement and fixation of a floating columellar strut. Results: Three anatomical variations of the medial crura were noted: type 1, asymmetric parallel (n = 7); type 2, flared symmetric (n = 5); and type 3, straight symmetric (n = 5). A significant difference in tip projection after elevation of the skin envelope and closure was discovered between types 1 and 3 (p = 0.004). Type 2 medial crura were found to have a mean reduction of 1.0 mm. Suture techniques resulted in return to baseline tip projection for types 1 and 2. Columellar strut placement increased tip projection in all types. Conclusions: Changes in tip projection after an open rhinoplasty depend on the shape of the medial crura. Straight symmetric (type 3) cartilages can maintain tip projection without any additional intervention during an open rhinoplasty. Asymmetric parallel (type 1) or flared symmetric (type 2) variants will require interdomal and medial crural sutures to maintain baseline tip projection.
All Around the Nose, 2019
The foundation and support of the nasal tip are based on the shape, strength, and location of the lower lateral cartilages (LLC) as well as their association with the ligaments. In addition, the nasal tip is supported by the upper lateral nostril cartilage, septum, base, and pyriform aperture. Before surgery, an examination may shed light on nasal tip deformities, including primary and/or other imbalances. Iatrogenic injury to the nasal tip may reduce structural support. In addition, cephalic pruning of the LLCs, resection, dorsal reduction, nasal incisions, and/or base resections may contribute to a significant loss in tip protrusion. Open rhinoplasty may also result in tip diminution upon soft tissue disruption. The approach is important to surgically expose the skeletal structures. Open or closed surgical methods are useful for tip rhinoplasty. The selection is strategic and is based on the difficulty and the surgeon’s expertise. Non-delivery or delivery approaches are achieved. ...
Preservation of the Nasal Valve Area With a Lateral Crural Hinged Flap: A Cadaveric Study
Aesthetic Plastic Surgery, 2012
Background Overresection of the lateral crura of the lower lateral cartilages is referred to as the most common cause of nasal valve collapse after rhinoplasty. The modern approach to functional rhinoplasty recognizes the importance of the tip framework's structural integrity and preserves tip support. Methods Traditional cephalic resections of lateral crura were performed on one side of five adult cadaver noses. On the opposite sides, hinged flaps of lateral crura were created. The noses were cross-sectioned at or near the internal nasal valve level, and the difference between the two sides was described.
Gradual approach to refinement of the nasal tip: surgical results
Brazilian journal of otorhinolaryngology
The complexity of the nasal tip structures and the impact of surgical maneuvers make the prediction of the final outcome very difficult. Therefore, no single technique is enough to correct the several anatomical presentations, and adequate preoperative planning represents the basis of rhinoplasty. To present results of rhinoplasty, through the gradual surgical approach to nasal tip definition based on anatomical features, and to evaluate the degree of patient satisfaction after the surgical procedure. Longitudinal retrospective cohort study of the medical charts of 533 patients of both genders who underwent rhinoplasty from January of 2005 to January of 2012 was performed. Cases were allocated into seven groups: (1) no surgery on nasal tip; (2) interdomal breakup; (3) cephalic trim; (4) domal suture; (5) shield-shaped graft; (6) vertical dome division; (7) replacement of lower lateral cartilages. Group 4 was the most prevalent. The satisfaction rate was 96% and revision surgery occu...
Nasal Tip Contouring Using Lower Lateral Cartilages
Journal of Craniofacial Surgery, 2011
Nasal tip management is the most important and challenging part of rhinoplasty surgery. For nasal tip management, optimal nasal tip projection and rotation must be maintained. For this reason, several methods have been developed to obtain optimal results. In this article, we share with the rhinoplasty surgeons how we use cartilage grafts for nasal tip projection, nasal tip shaping, and maintaining natural and symmetric appearance and avoid ''visible cartilage'' problem by using a simple and easily applicable method. After performing standard open rhinoplasty techniques, we used the cephalic portion of the lower lateral cartilages to overgraft the already placed numerous layers of shield or onlay grafts. All the cartilage grafts are sutured in their place to prevent malpositions or undesired angularities. We operated on 1480 patients between September of 2002 and September of 2009 for rhinoplasty. Ages of the patients range from 18 to 58 years with nasal tip ptosis. We performed 1235 primary rhinoplasties and 245 secondary rhinoplasties. Of 365 patients, who were followed up regularly, 330 (approximately 90%) were operated on according to this technique and were included in the study. By using such an overgrafting technique for nasal tip, we obtained satisfactory results both by the patients and by the surgeons. Satisfactory results and being a facilitating method for shaping of nasal tip are the advantages of this technique.
Indian Journal of Plastic Surgery
Background Setting the angle of tip rotation is of utmost importance in achieving satisfactory results in rhinoplasty. Conventionally the upward rotation of the tip requires shortening of the septum by caudal resection and shortening of the lateral walls by cephalic trim of the alar cartilages. The results are usually assessed subjectively. We describe the use of objective parameters to ensure accuracy of nasal tip rotation in patients operated with “cock-up” alar cartilage flaps, a modification of the cephalic trim. Methods Fifteen patients with a long nose having adequate width of lateral crura, desiring a shorter nose with upward tip rotation, were included in the study. Values of preoperative and desired nasolabial angle (from morphed images), and the derived columellar–labial angle were documented. Nasal tip rotation was set to the derived angle and maintained using cock-up alar cartilage flaps. The outcome was evaluated by digital measurements of the nasolabial angle and patie...