Lateral crural setback: an analysis on tip rotation

Authors

  • Phillip R. Langsdon Department of Otolaryngology and Facial Plastic Surgery, The Langsdon Clinic and UTHSC, Germantown, Tennessee, USA
  • Ronald J. Schroeder Department of Otolaryngology and Facial Plastic Surgery, The Langsdon Clinic and UTHSC, Germantown, Tennessee, USA
  • Hani Rayess Department of Otolaryngology and Facial Plastic Surgery, The Langsdon Clinic and UTHSC, Germantown, Tennessee, USA
  • William Clinkscales Department of Otolaryngology and Facial Plastic Surgery, The Langsdon Clinic and UTHSC, Germantown, Tennessee, USA

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20221643

Keywords:

Rhinoplasty, Nasal tip, Tip rotation, Lateral crura

Abstract

Background: Increasing nasal tip rotation is a common objective during rhinoplasty. When ptosis is either totally or partially the result of an excessive lateral crura length, strength, or position, various techniques have been used to shorten the lateral crura in order to reduce its relative inferior ptotic force. Techniques that involve division or amputation of the cartilage have been shown to be effective, but may sometimes weaken the cartilage’s shear and horizontal load strength, thus increasing the chances of unwanted sequalae in alar and/or tip contour. We presented our lateral crural setback technique as another option to allow the tip to rotate while maintaining the lateral architectural structure, end to end continuity, and horizontal load and shear strength.

Methods: Retrospective review of 20 patients undergoing cosmetic rhinoplasty who had a lateral crural setback cartilage repositioning maneuver. The primary outcomes measured after one year of follow-up were nasal tip rotation and projection. Nasal tip rotation was assessed by measures of the nasolabial angle using three different methods.

Results: There was a statistically significant increase in nasolabial angle using all 3 methods for measuring nasal tip rotation. The average increase in nasal tip rotation for all methods was 10.7° (p<0.0001). There was a statiscically significant decrease in tip projection. No alar distortion or complications were noted.

Conclusions: The lateral crural setback technique can be used to increase nasal tip rotation while preserving the integrity of the lateral crura. No alar distortion or complications were noted from this procedure.  

References

Anderson JR. A reasoned approach to nasal base surgery. Arch Otolaryngol. 1984;110(6):349-58.

Constantinides M, Liu ES, Miller PJ, Adamson PA. Vertical lobule division in rhinoplasty: maintaining an intact strip. Arch Facial Plast Surg. 2001;3(4):258-63.

Kridel RW, Konior RJ. Controlled nasal tip rotation via the lateral crural overlay technique. Arch Otolaryngol Head Neck Surg. 1991;117(4):411-5.

Goldman IB. The importance of the mesial crura in nasal-tip reconstruction. AMA Arch Otolaryngol. 1957;65(2):143-7.

Kridel RW, Konior RJ. Dome truncation for management of the overprojected nasal tip. Ann Plast Surg. 1990;24(5):385-96.

Harris R, Nagarkar P, Amirlak B. Varied Definitions of Nasolabial Angle: Searching for Consensus Among Rhinoplasty Surgeons and an Algorithm for Selecting the Ideal Method. Plast Reconstr surgery Glob open. 2016;4(6):e752.

Goode RL. Proportions of the Aesthetic Face. New York, NY: Thiem-Stratton. 1984.

Kridel RW, Scott BA, Foda HM. The tongue-in-groove technique in septorhinoplasty. A 10-year experience. Arch Facial Plast Surg. 1999;1(4):246-56.

Salyer KE. Primary correction of the unilateral cleft lip nose: a 15-year experience. Plast Reconstr Surg. 1986;77(4):558-68.

Webster RC, Smith RC. Lateral crural retrodisplacement for superior rotation of the tip in rhinoplasty. Aesthetic Plast Surg. 1979;3(1):65-78.

Sazgar AA. Lateral crural setback with cephalic turn-in flap: a method to treat the drooping nose. Ach Facial Plast Surg. 2010;12(6):427-30.

Toriumi DM, Asher SA. Lateral crural repositioning for treatment of cephalic malposition. Facial Plastic Surg Clin North Am. 2015;23(1):55-71.

Gunter JP, Friedman RM. Lateral crural strut graft: technique and clinical applications in rhinoplasty. Plast Reconstr Surg. 1997;99(4):943-52.

Langsdon P, Schroeder R, Rayess H, Clinkscales W. Lateral Crural Setback: A Preservation Technique to Increase Tip Rotation. Facial Plastic Surg Aesthet Med. 2021.

Foda HMT, Kridel RWH. Lateral crural steal and lateral crural overlay. An objective evaluation. Arch Otolaryngol - Head Neck Surg. 1999;125(12):1365-70.

Powell N HB. Proportions of the Aesthetic Face. New York, NY: Thieme Medical Publishers. 1984.

Fitzgerald JP, Nanda RS, Currier GF. An evaluation of the nasolabial angle and the relative inclinations of the nose and upper lip. Am J Orthod Dentofacial Orthop. 1992;102(4):328-34.

Armijo BS, Brown M, Guyuron B. Defining the ideal nasolabial angle. Plast Reconstr Surg. 2012;129(3):759-64.

Kim DW, Egan KK. Metrics of nasal tip rotation: a comparative analysis. Laryngoscope. 2006;116(6):872-7.

Downloads

Published

2022-06-24

Issue

Section

Original Research Articles