Lateral Crural Repositioning: Implications on Nasal Function

Abstract

There are many concepts for surgical management of the nasal tip with varying outcomes on esthetics and nasal function. Nasal tip surgery can influence nasal function based on how the techniques can alter lateral wall integrity. A retrospective chart review of rhinoplasty patients undergoing lateral crural strut grafting (LCSG) with and without repositioning from 2009 to 2017 of the primary author (D.M.T.) was performed. Preoperative and postoperative Nasal Obstruction Symptom Evaluation (NOSE) scores were analyzed. In our study, 832 subjects were evaluated. The mean preoperative NOSE score of all subjects was 35.48. The longest follow-up mean was 652.07 days with a mean NOSE score of 7.07 (p < 0.0001). In the LCSG group, the mean preoperative NOSE score was 22.97. The longest follow-up mean was 583.29 days with a mean NOSE score of 7.22 (p < 0.0001). In the LCSG with repositioning group, the mean preoperative NOSE score was 43.42. The longest follow-up mean was 692.36 days with a mean NOSE score of 7.60 (p < 0.0001). LCSGs with or without repositioning improves nasal function showing significant improvement in NOSE scores. The use of these techniques require adhering to several technical points to maximize outcomes and to avoid deformity.

Keywords

rhinoplasty - lateral crura - lateral crural strut graft - lateral crural repositioning - nasal valve

Publikationsverlauf

Artikel online veröffentlicht:
14. September 2023

• References

• 1 Toriumi DM. New concepts in nasal tip contouring. Arch Facial Plast Surg 2006; 8 (03) 156-185
• 2 Toriumi DM. Nasal tip contouring: anatomic basis for management. Facial Plast Surg Aesthet Med 2020; 22 (01) 10-24
• 3 Toriumi DM. Structure Rhinoplasty: Lessons Learned in Thirty Years. DMT Publishing; 2019
• 4 Toriumi DM, Asher SA. Lateral crural repositioning for treatment of cephalic malposition. Facial Plast Surg Clin North Am 2015; 23 (01) 55-71
• 5 Kovacevic M, Wurm J. Cranial tip suture in nasal tip contouring. Facial Plast Surg 2014; 30 (06) 681-687
• 6 Davis RE. Lateral crural tensioning for refinement of the wide and underprojected nasal tip: rethinking the lateral crural steal. Facial Plast Surg Clin North Am 2015; 23 (01) 23-53
• 7 Cakir B. Aesthetic Septorhinoplasty. Heidelberg: Springer; 2016
• 8 Toriumi DM. Caudal septal extension graft for correction of the retracted columella. Op Tech Otol Head Neck Surg 1995; 6 (04) 311-318
• 9 World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 2013; 310 (20) 2191-2194
• 10 United States Department of Health and Human Services Office for Civil Rights. Health Insurance Portability and Accountability Act Research. 2002, revised 2017;45 CFR 164.501, 164.508, 164.512(i)
• 11 Stewart MG, Witsell DL, Smith TL, Weaver EM, Yueh B, Hannley MT. Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale. Otolaryngol Head Neck Surg 2004; 130 (02) 157-163
• 12 Burstein FD. Prevention and correction of airway compromise in rhinoplasty. Ann Plast Surg 2008; 61 (06) 595-600
• 13 Afifi AM, Kempton SJ, Gordon CR. et al. Evaluating current functional airway surgery during rhinoplasty: a survey of the American Society of Plastic Surgeons. Aesthetic Plast Surg 2015; 39 (02) 181-190
• 14 Most SP. Comparing methods for repair of the external valve: one more step toward a unified view of lateral wall insufficiency. JAMA Facial Plast Surg 2015; 17 (05) 345-346
• 15 Most SP. Trends in functional rhinoplasty. Arch Facial Plast Surg 2008; 10 (06) 410-413
• 16 Gunter JP, Friedman RM. Lateral crural strut graft: technique and clinical applications in rhinoplasty. Plast Reconstr Surg 1997; 99 (04) 943-952 , discussion 953–955
• 17 Taştan E, Yücel ÖT, Aydin E, Aydoğan F, Beriat K, Ulusoy MG. The oblique split method: a novel technique for carving costal cartilage grafts. JAMA Facial Plast Surg 2013; 15 (03) 198-203
• 18 Rohrich RJ, Raniere Jr J, Ha RY. The alar contour graft: correction and prevention of alar rim deformities in rhinoplasty. Plast Reconstr Surg 2002; 109 (07) 2495-2505 , discussion 2506–2508