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A Technique for Treatment of Lateral Crus Malposition and Alar Rim Retraction Simultaneously in Rhinoplasty: Caudal Extended Lateral Crural Strut Graft

Year 2021, Volume: 7 Issue: 3, 223 - 227, 01.11.2021
https://doi.org/10.30934/kusbed.885453

Abstract

Objective: Cephalic malposition and weakness of the lateral crus may result in a long alar line, boxy nasal tip, parenthesis-deformity of the alar rim and external nasal valve insufficiency in deep inspiration, in addition to alar retraction. There is no gold standard method for correcting alar retraction and lateral crus deformities in rhinoplasty operations. Caudal extended lateral crural strut (CELCS) graft is a technique used to correct malposition of the lateral crus, to strengthen a weak lateral crus and to correct the alar rim retraction. An autologous septal cartilage graft may be used during CELCS.
Methods: CELCS graft was placed in 46 primary, open rhinoplasty procedures between 2014 and 2019. The graft was harvested from septal cartilage and placed on the lateral crus so that the cephalic areas overlapped while the caudal portion would extend into the pocket created in the caudal rim.
Results: Of the 46 patients, 30 (65.2%) were female and 16 (34.8%) were male. Median (range) age was 32 (23 to 41) years. All patients underwent CELCS graft, placed to correction cephalic malposition and alar rim retraction simultaneously. The average follow-up period was 12 months (9-15 months). Satisfactory results were achieved in all patients.
Conclusion: CELCS graft was a successful method to correct both lateral crus malposition and alar rim retraction simultaneously.

References

  • Gunter JP, Rohrich RJ, Friedman RM. Classification and correction of alar-columellar discrepancies in rhinoplasty. Plast Reconstr Surg. 1996;97:643-648. doi:10.1097/00006534-199603000-00026
  • 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;110:1116-1133. doi:10.1097/01.PRS.0000021870. 72613.FC
  • Kim JH, Park SW, Oh WS, et al. New classification for correction of alar retraction using the alar spreader graft. Aesthetic Plast Surg. 2012;36:832-841. doi:10.1007/s00266-012-9901-6
  • Rohrich RJ, Adams WP. The boxy nasal tip: Classification and management based on alar cartilage suturing techniques. Plast Reconstr Surg. 2001;107:1849-1863.
  • McKinney P. Management of the bulbous nose. Plast Reconstr Surg. 2000;106:906-917.
  • Constantian MB, Clardy RB. The relative importance of septal and nasal valvular surgery in correcting airway obstruction in primary and secondary rhinoplasty. Plast Reconstr Surg. 1996;98:38-54; discussion 5-8. doi:10.1097/00006534-199607000-00007
  • Lee M, Zwiebel S, Guyuron B. Frequency of the preoperative flaws and commonly required maneuvers to correct them: A guide to reducing the revision rhinoplasty rate. Plast Reconstr Surg. 2013;132:769-776. doi:10.1097/PRS.0b013e3182a01457
  • Hirohi T, Yoshimura K. Surgical correction of retracted nostril rim with auricular composite grafts and anchoring suspencion. Aesthetic Plast Surg. 2003;27:418-422.
  • Mohebbi A, Azizi A, Tabatabaiee S. Repositioned lateral crural flap technique for cephalic malposition in rhinoplasty. Plast Surg (Oakv). 2015;23(3):183-188. doi:10.4172/plastic-surgery.1000933
  • Yong JJ, Sung MK, Dae HL, Seung YS. Simple correction of alar retraction by conchal cartilage extension graft. Arch Plast. Sur. 2016;43:564-569.
  • Sheen JH, Sheen AP. Aesthetic Rhinoplasty. 2nd ed. St. Louis: Quality Medical Publishing; 1998.
  • Perkins SW, Sufyan AS. The alar-spanning suture: a useful tool in rhinoplasty to refine the nasal tip. Arch Facial Plast Surg. 2011;13(6):421-424. doi:10.1001/archfacial.2011.68
  • Gruber RP, Nahai F, Bogdan MA, Friedman GD. Changing the convexity and concavity of nasal cartilages and cartilage grafts with horizontal mattress sutures, part II: clinical results. Plast Reconstr Surg. 2005;115(2):595-606. doi:10.1097/01.prs.0000150146.04465.81
  • Cervelli V, Spallone D, Bottini JD, et al. Alar batten cartilage graft: treatment of internal and external nasal valve collapse. Aesthetic Plast Surg. 2009;33(4):625-634. doi:10.1007/s00266-009-9349-5
  • Boahene KD, Hilger PA. Alar rim grafting in rhinoplasty: indications, technique, and outcomes. Arch Facial Plast Surg. 2009;11(5):285-289. doi:10.1001/archfacial.2009.68
  • Dayan SH, Arkins JP. The endonasal lateral crural underlay and sandwich grafts. Aesthetic Surg J. 2011;31(1):30-39. doi:10.1177/1090820X10391779
  • Apaydın F. Lateral crural turn-in flap in functional rhinoplasty. Arch Facial Plast Surg. 2012;14(2):93-96. doi:10.1001/archfacial.2011.798
  • Murakami CS, Barrera JE, Most SP. Preserving structural integrity of the alar cartilage in aesthetic rhinoplasty using a cephalic turn-in flap. Arch Facial Plast Surg. 2009;11(2):126-128. doi:10.1001/archfacial.2008.524
  • Gunter JP, Friedman RM. Lateral crural strut graft: technique and clinical applications in rhinoplasty. Plast Reconstr Surg. 1997;99(4):943-952. doi:10.1097/00006534-199704000-00001
  • Sheen JH. Rhinoplasty: personal evolution and milestones. Plast Reconstr Surg. 2000;105:1820-1852. doi:10.1097/00006534-200004050-00033
  • Boccieri A, Raimondi G. The lateral crural stair step technique: a modification of the kridel lateral crural overlay technique. Arch Facial Plast Surg. 2008;10:56-64. doi:10.1001/archfacial.2007.7
  • Tellioglu AT, Cimen K. Turn-in folding of the cephalic portion of the lateral crus to support the alar rim in rhinoplasty. Aesthetic Plast Surg. 2007;31:306-310. doi:10.1007/s00266-006-0246-x
  • Bruintjes TD, van Olphen AF, Hillen, E H Huizing. A functional anatomic study of the relationship of the nasal cartilages and muscles to the nasal valve area. Laryngoscope. 1998;108:1025-1032. doi:10.1097/00005537-199807000-00014
  • Oktem F, Tellioğlu AT, Menevşe GT. Cartilage Z Plasty on lateral crus for treatment of alar cartilage malposition. J Plast Reconstr Aesthet Surg. 2010;63:801-808. doi:10.1016/j.bjps.2009.01.076

Rinoplasti Ameliyatında Lateral Krus Malpozisyonu ve Alar Rim Retraksiyonunun Simültane Düzeltilmesi: Kaudale Uzatılmış Lateral Krus Strut Grefti

Year 2021, Volume: 7 Issue: 3, 223 - 227, 01.11.2021
https://doi.org/10.30934/kusbed.885453

Abstract

Amaç: Sefalik malpozisyon ve zayıf lateral kurus birlikteliği uzun alar çizgi, boxy burun ucu, parantez rim deformitesi ve eksternal nazal valv yetmezliği yanında alar rimde çekintiye neden olur. Lateral kurus deformitesi ve alar rim çekintisini eş zamanlı düzelten altın standart tedavi yöntemi yoktur. Hastanın septal kartilajından alınarak kaudal kenarı rime uzanacak şekilde lateral kurusun üzerine adapte edilen “kaudale uzatılmış lateral kurus strat grefti” kurusu güçlendirirken rimdeki çekintiyide düzeltir.
Yöntem: Kaudale uzatılmış lateral kurus strat grefti, 2014-2019 yılları arasında primer açık rinoplasti uygulanan 46 hastada kullanıldı. Septal kartilajdan alınan greft sefalik tarafta lateral kurusla üst üste, kaudal tarafta rimde açılan poşa gelecek şekilde konuldu.
Bulgular: Hastaların 30’u (%65,2) kadın, 16’sı (%34,8) erkekti. Hastaların ortalama yaşı 32’ydi (23-41). Kaudale uzatılmış lateral kurus strat grefti tüm hastalarda sefalik malpozisyon ve rim çekintisini eş zamanlı düzeltmek için kullanıldı. Ortalama takip süresi 12 aydı (9-15 ay). Tüm hastalarda başarılı sonuçlar elde edildi.
Sonuç: Kaudale uzatışmış lateral kurus grefti lateral kurusun sefalik malpozisyonu ile alar rimdeki çekintiyi eş zamanlı düzeltebilen başarılı bir yöntemdir.

References

  • Gunter JP, Rohrich RJ, Friedman RM. Classification and correction of alar-columellar discrepancies in rhinoplasty. Plast Reconstr Surg. 1996;97:643-648. doi:10.1097/00006534-199603000-00026
  • 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;110:1116-1133. doi:10.1097/01.PRS.0000021870. 72613.FC
  • Kim JH, Park SW, Oh WS, et al. New classification for correction of alar retraction using the alar spreader graft. Aesthetic Plast Surg. 2012;36:832-841. doi:10.1007/s00266-012-9901-6
  • Rohrich RJ, Adams WP. The boxy nasal tip: Classification and management based on alar cartilage suturing techniques. Plast Reconstr Surg. 2001;107:1849-1863.
  • McKinney P. Management of the bulbous nose. Plast Reconstr Surg. 2000;106:906-917.
  • Constantian MB, Clardy RB. The relative importance of septal and nasal valvular surgery in correcting airway obstruction in primary and secondary rhinoplasty. Plast Reconstr Surg. 1996;98:38-54; discussion 5-8. doi:10.1097/00006534-199607000-00007
  • Lee M, Zwiebel S, Guyuron B. Frequency of the preoperative flaws and commonly required maneuvers to correct them: A guide to reducing the revision rhinoplasty rate. Plast Reconstr Surg. 2013;132:769-776. doi:10.1097/PRS.0b013e3182a01457
  • Hirohi T, Yoshimura K. Surgical correction of retracted nostril rim with auricular composite grafts and anchoring suspencion. Aesthetic Plast Surg. 2003;27:418-422.
  • Mohebbi A, Azizi A, Tabatabaiee S. Repositioned lateral crural flap technique for cephalic malposition in rhinoplasty. Plast Surg (Oakv). 2015;23(3):183-188. doi:10.4172/plastic-surgery.1000933
  • Yong JJ, Sung MK, Dae HL, Seung YS. Simple correction of alar retraction by conchal cartilage extension graft. Arch Plast. Sur. 2016;43:564-569.
  • Sheen JH, Sheen AP. Aesthetic Rhinoplasty. 2nd ed. St. Louis: Quality Medical Publishing; 1998.
  • Perkins SW, Sufyan AS. The alar-spanning suture: a useful tool in rhinoplasty to refine the nasal tip. Arch Facial Plast Surg. 2011;13(6):421-424. doi:10.1001/archfacial.2011.68
  • Gruber RP, Nahai F, Bogdan MA, Friedman GD. Changing the convexity and concavity of nasal cartilages and cartilage grafts with horizontal mattress sutures, part II: clinical results. Plast Reconstr Surg. 2005;115(2):595-606. doi:10.1097/01.prs.0000150146.04465.81
  • Cervelli V, Spallone D, Bottini JD, et al. Alar batten cartilage graft: treatment of internal and external nasal valve collapse. Aesthetic Plast Surg. 2009;33(4):625-634. doi:10.1007/s00266-009-9349-5
  • Boahene KD, Hilger PA. Alar rim grafting in rhinoplasty: indications, technique, and outcomes. Arch Facial Plast Surg. 2009;11(5):285-289. doi:10.1001/archfacial.2009.68
  • Dayan SH, Arkins JP. The endonasal lateral crural underlay and sandwich grafts. Aesthetic Surg J. 2011;31(1):30-39. doi:10.1177/1090820X10391779
  • Apaydın F. Lateral crural turn-in flap in functional rhinoplasty. Arch Facial Plast Surg. 2012;14(2):93-96. doi:10.1001/archfacial.2011.798
  • Murakami CS, Barrera JE, Most SP. Preserving structural integrity of the alar cartilage in aesthetic rhinoplasty using a cephalic turn-in flap. Arch Facial Plast Surg. 2009;11(2):126-128. doi:10.1001/archfacial.2008.524
  • Gunter JP, Friedman RM. Lateral crural strut graft: technique and clinical applications in rhinoplasty. Plast Reconstr Surg. 1997;99(4):943-952. doi:10.1097/00006534-199704000-00001
  • Sheen JH. Rhinoplasty: personal evolution and milestones. Plast Reconstr Surg. 2000;105:1820-1852. doi:10.1097/00006534-200004050-00033
  • Boccieri A, Raimondi G. The lateral crural stair step technique: a modification of the kridel lateral crural overlay technique. Arch Facial Plast Surg. 2008;10:56-64. doi:10.1001/archfacial.2007.7
  • Tellioglu AT, Cimen K. Turn-in folding of the cephalic portion of the lateral crus to support the alar rim in rhinoplasty. Aesthetic Plast Surg. 2007;31:306-310. doi:10.1007/s00266-006-0246-x
  • Bruintjes TD, van Olphen AF, Hillen, E H Huizing. A functional anatomic study of the relationship of the nasal cartilages and muscles to the nasal valve area. Laryngoscope. 1998;108:1025-1032. doi:10.1097/00005537-199807000-00014
  • Oktem F, Tellioğlu AT, Menevşe GT. Cartilage Z Plasty on lateral crus for treatment of alar cartilage malposition. J Plast Reconstr Aesthet Surg. 2010;63:801-808. doi:10.1016/j.bjps.2009.01.076
There are 24 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section Original Article / Medical Sciences
Authors

Can İlker Demir 0000-0001-6725-031X

Emrah Kağan Yaşar 0000-0003-0572-1248

Murat Şahin Alagöz 0000-0002-5521-7173

Publication Date November 1, 2021
Submission Date February 23, 2021
Acceptance Date September 20, 2021
Published in Issue Year 2021 Volume: 7 Issue: 3

Cite

APA Demir, C. İ., Yaşar, E. K., & Alagöz, M. Ş. (2021). A Technique for Treatment of Lateral Crus Malposition and Alar Rim Retraction Simultaneously in Rhinoplasty: Caudal Extended Lateral Crural Strut Graft. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi, 7(3), 223-227. https://doi.org/10.30934/kusbed.885453
AMA Demir Cİ, Yaşar EK, Alagöz MŞ. A Technique for Treatment of Lateral Crus Malposition and Alar Rim Retraction Simultaneously in Rhinoplasty: Caudal Extended Lateral Crural Strut Graft. KOU Sag Bil Derg. November 2021;7(3):223-227. doi:10.30934/kusbed.885453
Chicago Demir, Can İlker, Emrah Kağan Yaşar, and Murat Şahin Alagöz. “A Technique for Treatment of Lateral Crus Malposition and Alar Rim Retraction Simultaneously in Rhinoplasty: Caudal Extended Lateral Crural Strut Graft”. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi 7, no. 3 (November 2021): 223-27. https://doi.org/10.30934/kusbed.885453.
EndNote Demir Cİ, Yaşar EK, Alagöz MŞ (November 1, 2021) A Technique for Treatment of Lateral Crus Malposition and Alar Rim Retraction Simultaneously in Rhinoplasty: Caudal Extended Lateral Crural Strut Graft. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi 7 3 223–227.
IEEE C. İ. Demir, E. K. Yaşar, and M. Ş. Alagöz, “A Technique for Treatment of Lateral Crus Malposition and Alar Rim Retraction Simultaneously in Rhinoplasty: Caudal Extended Lateral Crural Strut Graft”, KOU Sag Bil Derg, vol. 7, no. 3, pp. 223–227, 2021, doi: 10.30934/kusbed.885453.
ISNAD Demir, Can İlker et al. “A Technique for Treatment of Lateral Crus Malposition and Alar Rim Retraction Simultaneously in Rhinoplasty: Caudal Extended Lateral Crural Strut Graft”. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi 7/3 (November 2021), 223-227. https://doi.org/10.30934/kusbed.885453.
JAMA Demir Cİ, Yaşar EK, Alagöz MŞ. A Technique for Treatment of Lateral Crus Malposition and Alar Rim Retraction Simultaneously in Rhinoplasty: Caudal Extended Lateral Crural Strut Graft. KOU Sag Bil Derg. 2021;7:223–227.
MLA Demir, Can İlker et al. “A Technique for Treatment of Lateral Crus Malposition and Alar Rim Retraction Simultaneously in Rhinoplasty: Caudal Extended Lateral Crural Strut Graft”. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi, vol. 7, no. 3, 2021, pp. 223-7, doi:10.30934/kusbed.885453.
Vancouver Demir Cİ, Yaşar EK, Alagöz MŞ. A Technique for Treatment of Lateral Crus Malposition and Alar Rim Retraction Simultaneously in Rhinoplasty: Caudal Extended Lateral Crural Strut Graft. KOU Sag Bil Derg. 2021;7(3):223-7.