Cephalic lateral crural advancement flap

Abstract

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.

State of the Evidence for Preservation Rhinoplasty: A Systematic Review

“…25,34,50,52,58,60,66 Significant improvement in ROE, nasal patency scores, SCHNO-S-C/O, NOSE, and VAS-F/C was seen following the sandwich technique described by Öztürk, as well as the mini-LCSG, LCSG, cephalic lateral crural advancement (CLCA) flap, LCO technique, cephalic turn-in flap, and superior-based sliding flap technique with complete cartilage preservation. 25,50,52,58,60,66 Significant improvement was also seen in SCHNOS-O/C scores following a subdorsal septal approach encompassing all three preservation techniques. 34 Abdelwahab et al found a significant improvement in both SCHNOS-C and VAS-C (p < 0.05) for all lateral crural preservation techniques in cosmetic rhinoplasty.…”

“…58,66 Similarly, Öztürk and Bulutboth demonstrated a significant improvement in ROE score at 12 months following either the sandwich technique or CLCA flap. 52,60 Improvement in SCHNOS-O score was seen only in combined cosmetic and functional rhinoplasty with mini-LCSG, although there was an improvement in nasal patency Likert scale scores or VAS-F following both the sandwich technique and CLCA flap. 52,60,66 The remaining references included in this group focus on subjective outcomes, complication rates, and revisions rates with no statistically significant data available.…”

“…52,60 Improvement in SCHNOS-O score was seen only in combined cosmetic and functional rhinoplasty with mini-LCSG, although there was an improvement in nasal patency Likert scale scores or VAS-F following both the sandwich technique and CLCA flap. 52,60,66 The remaining references included in this group focus on subjective outcomes, complication rates, and revisions rates with no statistically significant data available. 1,10,18,46,49 51,53,54,56,57,59,61-64,72 Seventeen studies reported complication rates ranging from 0.00 to 22.10%.…”

“…69 Seven additional references included PROMs in the analysis of lateral crural preservation techniques. 25,34,50,52,58,60,66 Significant improvement in ROE, nasal patency scores, SCHNO-S-C/O, NOSE, and VAS-F/C was seen following the sandwich technique described by Öztürk, as well as the mini-LCSG, LCSG, cephalic lateral crural advancement (CLCA) flap, LCO technique, cephalic turn-in flap, and superior-based sliding flap technique with complete cartilage preservation. 25,50,52,58,60,66 Significant improvement was also seen in SCHNOS-O/C scores following a subdorsal septal approach encompassing all three preservation techniques.…”

Lateral Crural Turn-Up Flap for Increasing the Volume of Cartilaginous Nasal Sidewall in Closed-Approach Dorsal Preservation Rhinoplasty

“…Also, some flaps have been described based on use of cartilage in the cephalic trim area. O'Halloran 8 described “lateral crural J flap,” Janis et al 9 described “lower lateral crural turnover flap,” Ozmen et al 10 described “sliding alar cartilage flap,” Apaydın 11 described “lateral crural turn-in flap,” Sazgar 12 described “lateral crural hinged flap,” Bohluli et al 13 described “lateral crural suspension flap,” Ashtiani et al 14 described “lateral crural transposition flap,” Kuran et al 15 described “lateral crural rein flap,” Tas 16 described “superior-based transposition flap” and Bulut 17 described “cephalic lateral crural advancement flap.” The focus of all these defined flaps is on the lower third of the nose, such as obtaining stronger lower lateral cartilages, supporting the nasal valves, controlling tip rotation. In all of these studies, flaps were designed symmetrically and bilaterally.…”