Repositioned lateral crural flap technique for cephalic malposition in rhinoplasty

Abstract

Background Cephalic malposition of the lower lateral cartilage (CMLLC) is a relatively common anatomical variant, particularly in Middle Eastern patients. The characteristics of CMLLC include long alar creases, a boxy and ball-shaped nasal tip, parenthesis tip deformity and external valvular incompetence. The gold standard for correcting CMLLC is the lateral crural strut graft (Gunter graft), but many patients experience problems after this technique. Objective To evaluate the efficacy of the repositioned lateral crural flap (RLCF) technique in correcting CMLLC, and to discuss the cosmetic and functional results. Methods In the present study, 123 primary septorhinoplasty operations using the RLCF technique were performed between May 2012 and March 2013. The mean follow-up period was 11.4 months (range nine to 24 months). Four parameters were measured and compared pre- and postoperatively: the angle between the line connecting the maximum convexity of the lower lateral cartilage (LLC) to the tip-defining point and midline on each side (angle of rotation); the total distance between the maximum convexity of LLC right and left to midline (representing the size of the parenthesis deformity); satisfaction scale rating of the patients' nasal tip appearance; and the satisfaction scale rating of patients' breathing through their nostrils. Results The mean angle of the LLC to the midline significantly increased and the mean distance between the maximum convexities was significantly reduced, indicating correction of the malposition and reduction of the parenthesis deformity, respectively. The mean satisfactory scale ratings of nasal tip appearance and breathing quality were also significantly improved. Conclusion CMLLC can be corrected using the RLCF technique, resulting in both aesthetic and functional improvements.

Oblique Turnover Flap for Repositioning and Flattening of the Lateral Crura: A Novel Technique to Manage Cephalic Malposition of Lower Lateral Cartilage

“…8 Repositioned lateral crural flap technique of Mohebbi et al does not impede fine movements of the posterior alar rim, because the repositioned lateral crura support only the anterior part of the alar rim, as in normal anatomy. 13 This technique does not require extra cartilage graft material. In this method, the lateral crus was obliquely divided (probably it was better not to call it "flap" technique) at the point of maximum convexity at different distances from the dome and two segments were prepared.…”

“…However, the authors recommend to perform it on patients with lower grades of cephalically positioned crura and moderate external valve incompetence. 13 In the Z plasty of the lateral crura of CMLLC, described by Oktem et al, they used consistent cartilage division in the "Z" shape, so it resulted in successful correction of alar cartilage malposition with aesthetic and functional improvements. 8 In 2008, Boccieri and Raimondi treated 22 patients with good results by using stair-step incision for dividing the lateral crura as anterior and posterior segments.…”

“…The p value for each comparison was calculated using SPSS version 21 (IBM Corporation); p < 0.05 was considered to be statistically significant for all comparisons. 13 The pre-and postoperative scores were compared. Intraoperatively we evaluated the condition of lateral crura of LLC and the angle between the central axis of the lateral cruras and the septum on each side, in each case, the angle was measured before applying OTOF technique and immediately after by using the protractor (►Fig.…”

“…5 We used the mentioned criteria to compare the position of LLC pre-and postoperatively. The authors of previous studies have suggested numerous techniques to correct malposition of LLC: [6][7][8][9][10][11][12][13][14] Gunter and Friedman described repositioning of the LLCs caudally with lateral crural strut graft, 6 others introduced composite grafts, 7 alar rim grafts, 14 and repositioning. 8 The stair-step technique was defined by Boccieri and Raimondi, 9 and it was modified by Ercan et al by adding lateral crural rim graft.…”

“…11 Also the alar rim flap and repositioned lateral crural flap techniques were proposed. 12,13 All of the techniques mentioned earlier have a definitive role in modern rhinoplasty surgery and, when selected appropriately, commonly lead to desired surgical outcomes. However, there are certain limitations to each of the aforementioned techniques.…”