Lateral Crural Suspension Flap: A Novel Technique to Modify and Stabilize the Nasolabial Angle

doi:10.1016/j.joms.2013.03.024

Journal of Oral and Maxillofacial Surgery

Volume 71, Issue 9, September 2013, Pages 1572-1576

https://doi.org/10.1016/j.joms.2013.03.024 Get rights and content

The proper nasolabial angle is a determinant factor in achieving a pleasant result in esthetic rhinoplasty surgery. Nasal tip position depends on various interrelated elements. Its rotation should be analyzed by assessing the nasolabial angle. An increase in this angle results in an upward tilt of the base of the nose with a concomitant decrease in nasal length. Several methods have been advocated to improve this angle; unfortunately, these techniques have considerable limitations in modifying and stabilizing nasal tip rotation. The general principles for rotating the nasal tip include removing the factors that resist the rotation of the lower lateral cartilages, creating space to accommodate them, rotating the lower lateral cartilages into the desired position, and stabilizing the cartilages in the desired position. Resection of the cephalic margin of the lateral crura fulfills these goals. This report describes a straightforward and stable method that uses cephalic portions of the lower lateral crural cartilages as 2 flaps to suspend the nasal tip to the septum to modify and stabilize the nasolabial angle.

Section snippets

Surgical Technique

This technique is best performed after completing dorsal surgery and during tip plasty. The upper lateral cartilages are split off the cartilaginous septum for a few millimeters near the cephalic portion of the lateral crura (if they are not separated during septal surgery). Next, the line of incision is marked on the lateral crural cartilage using a caliper and marker. A 6-mm strip of the cephalic lateral crura is left at the widest point of the lateral crura to facilitate the insertion of

Discussion

Correction of the nasal tip position and nasolabial angle is challenging in rhinoplasty. There are various elements that influence rotation of the nasal tip. The fibrous attachments of the lower lateral cartilages to the skin, upper lateral cartilages, piriform aperture, and caudal septum provide support and play a critical role in the position of the tip. Tip rotation may be increased with the use of several techniques alone or in conjunction. These techniques enable mobilization and upward

References (5)

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(1975)
R.J. Rohrich et al.
The effect of the columellar strut graft on nasal tip position in primary rhinoplasty
Plast Reconstr Surg
(2012)

There are more references available in the full text version of this article.

Cited by (20)

Do the size and extension of the external nasal splint have an effect on the osteotomy, brow lines, and long-term results of rhinoplasty: A prospective randomized controlled trial of 2 methods
2015, Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
The attachments of these cartilages to the nasal septum are usually cut during hump reduction or spreader graft placement.8,14 The attachments of the upper lateral cartilages to the lower lateral cartilages are usually cut during the cephalic trim.15 The attachments of these cartilages to the piriform aperture are modified during the lateral nasal wall osteotomy.7,8
While performing a lateral nasal wall osteotomy during a rhinoplasty, an intentional fracture is produced and the fractured segments are medialized to narrow a wide nasal base. The purpose of this study was to investigate the effect of size, shape, and extension of the external nasal splint on the osteotomy, brow lines, and long-term results of rhinoplasty.
The authors designed a randomized prospective clinical trial. The study population was composed entirely of patients who were voluntarily referred to the authors' department from May 2012 to May 2013. They were randomly divided into 2 equal groups. The primary predictor variable was splint type. For group 1, the external splint was extended beyond the osteotomy lines laterally and covered the overlying skin of the frontal process of the maxillary bone. For group 2, the external splint was trimmed above the osteotomy lines. The primary outcome variables were the levels of satisfaction with the dorsal esthetic lines, brow lines, and distinct osteotomy lines at 12 months after the operation. Demographic variables were gender and age. Mann-Whitney U test, χ² test, and t test were used to analyze the data. Results with a P value less than .05 were considered significant.
Forty healthy patients (American Society of Anesthesiologists status I and II; 18 men and 22 women; age range, 19 to 41 yr; mean, 31.4 yr) were selected. Although the level of satisfaction with the dorsal esthetic lines was higher in group 2, it was not significantly different from group 1 (P > .05). The levels of satisfaction with the brow lines and the distinct osteotomy lines were significantly higher in group 2 (P < .05).
The results of this study showed that when a nasal splint is extended beyond the frontal process of the maxilla rather than the base of the nasal bones, positioning of the bones and long-term results are unpredictable.
Modification of the lateral crural suspension flap
2014, Journal of Oral and Maxillofacial Surgery
Internal suspension sutures in tip rhinoplasty
2024, European Archives of Oto-Rhino-Laryngology
Lateral Crural Turn-Up Flap for Increasing the Volume of Cartilaginous Nasal Sidewall in Closed-Approach Dorsal Preservation Rhinoplasty
2023, Annals of Plastic Surgery
The Onlay Rotated Flap (ORF): An Original Technique for Nasal Tip Plasty
2022, Journal of Craniofacial Surgery
Rhinoplasty in Practice: An Algorithmic Approach to Modern Surgical Techniques
2022, Rhinoplasty in Practice: An Algorithmic Approach to Modern Surgical Techniques

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: Conflict of Interest Disclosures: None of the authors reported any disclosures.

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Craniomaxillofacial deformities/cosmetic surgeryLateral Crural Suspension Flap: A Novel Technique to Modify and Stabilize the Nasolabial Angle

Section snippets

Surgical Technique

Discussion

Otolaryngol Clin North Am

The effect of the columellar strut graft on nasal tip position in primary rhinoplasty

Plast Reconstr Surg

Craniomaxillofacial deformities/cosmetic surgery
Lateral Crural Suspension Flap: A Novel Technique to Modify and Stabilize the Nasolabial Angle