Facial Plast Surg 2021; 37(05): 666-672
DOI: 10.1055/s-0041-1726025
Original Research

Caudal Extension Graft of the Lower Lateral Cartilage: Technique and Aesthetic and Functional Results

Juliano de Oliveira Sales
1   Department of Otorrinolaringology, Mater Dei Rede de Saúde, Belo Horizonte, Minas Gerais, Brazil
,
Wolfgang Gubisch
2   Department of Facial Plastic Surgery, Marien Hospital Stuttgart, Stuttgart, Baden-Württemberg, Germany
,
Rodrigo Ribeiro Ferreira Duarte
1   Department of Otorrinolaringology, Mater Dei Rede de Saúde, Belo Horizonte, Minas Gerais, Brazil
,
Aline Souza Costa Teixeira Moreno
1   Department of Otorrinolaringology, Mater Dei Rede de Saúde, Belo Horizonte, Minas Gerais, Brazil
,
Felipe Marques de Oliveira
1   Department of Otorrinolaringology, Mater Dei Rede de Saúde, Belo Horizonte, Minas Gerais, Brazil
,
Lorena Martins de Oliveira Coura
3   Pontificia Universidade Catolica de Minas Gerais, Medical School, Belo Horizonte, Minas Gerais, Brazil
› Author Affiliations

Abstract

Here we describe a new technique to deal with alar retraction, a highly undesirable imperfection of the nose. The procedure involves placing a caudal extension graft below the vestibular portion of the lower lateral cartilage (LLC) after its detachment from the vestibular skin. The graft is fixed to the cartilage and, subsequently, to the vestibular tissue. The present retrospective study included 20 patients, 11 females and 9 males, with a mean age of 28.90 years. Follow-up ranged from 1 to 18 months. Surgery improved alar notching to a smoother dome shape and nostril exposure was reduced in every patient. The caudal extension graft of the LLC contributed to rise in overall patient satisfaction, as revealed by the postoperative increase of the Rhinoplasty Outcomes Evaluation (ROE) mean score from 40.0 to 79.17 (p < 0.0001). It also contributed to and improved functional outcomes, as indicated by the decrease of the Nasal Obstruction Symptom Evaluation (NOSE) mean score from 52.75 to 13.25 (p = 0.0001). Sex did not affect the mean ROE and NOSE scores. Thus, increased patient satisfaction measured by the ROE is present in both sexes and at both age groups but it is better detected in the first year after surgery. Functional improvements analyzed with NOSE are best detected in patients aged ≥ 30 years and in follow-ups of 11 months. The caudal extension graft of the LLC technique described herein effectively and safely corrects alar retraction and the collapse of the nasal valve while filling the soft triangle.



Publication History

Article published online:
14 April 2021

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  • References

  • 1 Barone M, Cogliandro A, Di Stefano N, Tambone V, Persichetti P. A systematic review of patient-reported outcome measures after rhinoplasty. Eur Arch Otorhinolaryngol 2017; 274 (04) 1807-1811
  • 2 Gunter JP, Friedman RM. Lateral crural strut graft: technique and clinical applications in rhinoplasty. Plast Reconstr Surg 1997; 99 (04) 943-952
  • 3 Jang YJ, Kim SM, Lew DH, Song SY. Simple correction of alar retraction by conchal cartilage extension grafts. Arch Plast Surg 2016; 43 (06) 564-569
  • 4 Kao WTK, Davis RE. Postsurgical alar retraction: etiology and treatment. Facial Plast Surg Clin North Am 2019; 27 (04) 491-504
  • 5 Kridel RW, Chiu RJ. The management of alar columellar disproportion in revision rhinoplasty. Facial Plast Surg Clin North Am 2006; 14 (04) 313-329
  • 6 Constantian MB. Indications and use of composite grafts in 100 consecutive secondary and tertiary rhinoplasty patients: introduction of the axial orientation. Plast Reconstr Surg 2002; 110 (04) 1116-1133
  • 7 Kim JH, Park SW, Oh WS, Lee JH. New classification for correction of alar retraction using the alar spreader graft. Aesthetic Plast Surg 2012; 36 (04) 832-841
  • 8 Grymer LF. Reduction rhinoplasty and nasal patency: change in the cross-sectional area of the nose evaluated by acoustic rhinometry. Laryngoscope 1995; 105 (4 Pt 1): 429-431
  • 9 Hirohi T, Yoshimura K. Surgical correction of retracted nostril rim with auricular composite grafts and anchoring suspension. Aesthetic Plast Surg 2003; 27 (05) 418-422
  • 10 Toriumi DM. Nasal tip contouring: anatomic basis for management. Facial Plast Surg Aesthet Med 2020; 22 (01) 10-24
  • 11 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
  • 12 Kim HS, Rho SG. The alar extension graft for retracted ala. J Korean Soc Plastic Reconstr Surg 2009; 36: 66-74
  • 13 Ellenbogen R. Alar rim lowering. Plast Reconstr Surg 1987; 79 (01) 50-57
  • 14 Gruber RP, Kryger G, Chang D. The intercartilaginous graft for actual and potential alar retraction. Plast Reconstr Surg 2008; 121 (05) 288e-296e
  • 15 Alexander AJ, Shah AR, Constantinides MS. Alar retraction: etiology, treatment, and prevention. JAMA Facial Plast Surg 2013; 15 (04) 268-274
  • 16 Alsarraf R, Larrabee Jr WF, Anderson S, Murakami CS, Johnson Jr CM. Measuring cosmetic facial plastic surgery outcomes: a pilot study. Arch Facial Plast Surg 2001; 3 (03) 198-201
  • 17 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
  • 18 Izu SC, Kosugi EM, Lopes AS. et al. Validation of the Rhinoplasty Outcomes Evaluation (ROE) questionnaire adapted to Brazilian Portuguese. Qual Life Res 2014; 23 (03) 953-958
  • 19 Bezerra TF, Padua FG, Pilan RR, Stewart MG, Voegels RL. Cross-cultural adaptation and validation of a quality of life questionnaire: the Nasal Obstruction Symptom Evaluation questionnaire. Rhinology 2011; 49 (02) 227-231
  • 20 Rohrich RJ, Afrooz PN. Revisiting the alar-columellar relationship: classification and correction. Plast Reconstr Surg 2019; 144 (02) 340-346
  • 21 Ballin AC, Kim H, Chance E, Davis RE. The articulated alar rim graft: reengineering the conventional alar rim graft for improved contour and support. Facial Plast Surg 2016; 32 (04) 384-397
  • 22 Gubisch W, Sinha V. Extracorporeal septoplasty-how we do it at Marienhospital Stuttgart Germany. Indian J Otolaryngol Head Neck Surg 2008; 60 (01) 16-19
  • 23 Khansa I, Khansa L, Pearson GD. Patient satisfaction after rhinoplasty: a social media analysis. Aesthet Surg J 2016; 36 (01) NP1-NP5
  • 24 Yang F, Liu Y, Xiao H, Li Y, Cun H, Zhao Y. Evaluation of preoperative and postoperative patient satisfaction and quality of life in patients undergoing rhinoplasty: a systematic review and meta-analysis. Plast Reconstr Surg 2018; 141 (03) 603-611
  • 25 Most SP. Analysis of outcomes after functional rhinoplasty using a disease-specific quality-of-life instrument. Arch Facial Plast Surg 2006; 8 (05) 306-309
  • 26 Rhee JS, Poetker DM, Smith TL, Bustillo A, Burzynski M, Davis RE. Nasal valve surgery improves disease-specific quality of life. Laryngoscope 2005; 115 (03) 437-440
  • 27 Floyd EM, Ho S, Patel P, Rosenfeld RM, Gordin E. Systematic review and meta-analysis of studies evaluating functional rhinoplasty outcomes with the NOSE score. Otolaryngol Head Neck Surg 2017; 156 (05) 809-815