Lateral crural overlay of the lower lateral cartilages, a technique to enhance nasal tip rotation, and reduce projection in the droopy nasal tip
DOI:
https://doi.org/10.15218/zjms.2018.003Keywords:
Lower Lateral Cartilages (LLC), Lateral Crural Overlap or overlay (LCO), Medial Crural Overlay (MCO), Nasal Tip Rotation, Nasal Tip ProjectionAbstract
Background and objective: Tip plasty is one of the most common feats encountered by the Aesthetic Rhinoplasty Surgeon. Tip rotation, with or without tip deprojection, is one of the challenging problems that face the surgeon, with many overwhelming techniques to correct rotation and projection of the nasal tip, including, but not limited to overlapping of the lateral crural cartilages. This study aimed to assess the efficacy and reliability of the technique of the lateral crural overlay of the lower lateral cartilages in enhancing nasal tip rotation and decreasing nasal tip projection.
Methods: This prospective study included 64 patients, who underwent primary, and secondary, open Rhinoplasty, with nasal droopy tip and nasal tip true overprojection problems. They have been treated in Sulaimaniyah Hospital for Burn and Plastic Surgery, and from Private Hospitals in Sulaimaniyah city. The age range was 18-34 years. Forty nine patients were female, the rest of the patients were male. They have been treated, primarily, for the tip drooping and to a lesser extent for nasal tip overprojection, by the senior author, with Lateral Crural Cartilages Overlay. The study conducted from April 2012 to January 2016. The patients, postoperatively, were followed up for up to one year. Goode ratio and Nasofacial angle deducted from real time photographs have been used to evaluate the amount of rotation and deprojection of the nasal tip.
Results: Overlapping of the Lateral Crura of the Lower Lateral Cartilages, is a safe and reasonable technic in achieving nasal tip rotation, with or without, projection reduction, of the droopy nose. The operative time and dissection are very encouraging. Complications associated with this technic are very negligible, with high patient satisfaction rates. Only five rhinoplasty patient has been revised for the sake of tip rotation/projection, in this series of cases. No Major complications happened in the collumellar skin incision or the nasal rim infracartilagenous incisions, nor in the undermined nasal vestibular skin separated from the undersurface of the Lower Lateral Cartilages.
Conclusion: Overlapping, or overlaying, of the lateral crura of the lower lateral cartilages, is a reasonable technique to enhance tip rotation, and reduction of the tip projection, by medial crural steal and telescoping of the incised lower lateral cartilages, with good aesthetic and functional outcomes, with reasonable complication rates, very low revision rate, and high patient satisfaction rates.
Metrics
References
Foda T. External rhinoplasty for the over projected nasal tip. English version of "Externe Rhinoplastik bei Nasenspitzenüberprojektion". J Ästhet Chir 2013; 6:26-32.
Foda T, Russell W, Kridel H. Lateral crural steal and lateral crural overlay, an objective evaluation. Arch Otolaryngology Head Neck Surg 1999; 125(12):1365-70.
Sajjadian A, Guyuron B. An algorithm for treatment of the drooping nose. Aesthetic Surg J 2009; 29:199-208.
Kridel RW, Konior RJ. Controlled nasal tip rotation via the lateral crural overlay technique. Arch Otolaryngology Head Neck Surg 1991; 117(4):411-5.
Soliemanzadeh P, Kridel RW. Nasal Tip Overprojection, Algorithm of Surgical Deprojection Techniques and introduction of medial crural overlay. Arch Facial Plast Surg 2005; 7(6):374-80.
Gubisch W, Eichhorn-Sens J. The sliding technique. A method to treat the overprojected nasal tip. Aesthetic Plast Surg 2008; 32(5):772-8.
Foda T. Alar Setback Technique, A controlled method of nasal tip deprojection. Arch Otolaryngol Head Neck Surg 2001; 127(11):1341-6.
Sazgar AA. Lateral Crural Setback with Cephalic Turn-in Flap , A method to treat the drooping nose. Arch Facial Plast Surg 2010; 12(6):427-30.
Chang CW, Simons RL. Hockey-Stick vertical dome division technique for overprojected and broad nasal tips. Arch Facial Plast Surg 2008; 10(2):88-92.
Foda T. Nasal Base Narrowing, The combined alar base excision technique. Arch Facial Plast Surg 2007; 9(1):30-4.
Wise JB, Becker SS, Sparano A, Steiger J, Becker DG. Intermediate Crural Overlay in Rhinoplasty, A deprojection technique that shortens the medial leg of the tripod without lengthening the nose. Arch Facial Plast Surg 2006; 8(4):240-4.
Gandomi B, Arzaghi MH, Rafatbakhsh M. The effectiveness of modified vertical dome division technique in reducing nasal tip projection in rhinoplasty. Iran J Med Sci 2011; 36(3):196-200.
Patel KB, Mendonca DA, Skolnick G, Woo AS. Anatomical study of the medial crura and the effect on nasal tip projection in open rhinoplasty. Plast Reconstr Surg 2013; 132(4):787-93.
Lee MR, Geissler P, Cochran S, Gunter JP, Rohrich RJ. Decreasing Nasal Tip Projection in Rhinoplasty. Plast Reconstr Surg 2014; 134(1):41e-9.
Datema FR, Lohuis PJ. Tongue-in-Groove setback of the medial crura to control nasal tip deprojection in open rhinoplasty. Aesthetic Plast Surg 2014; 39(1):53-62.
Busca GP, Amasio ME, Staffieri A. The surgery of the tip of the nose. Acta Otorhinolaryngol Ital 2002; 22(3 Suppl 70):7-29.
Lewis JR. Nasal tip projection: counterpoint. Plast Reconstr Surg 1987; 80(3):356-65.
Han SK, Lee DG, Kim JB, Kim WK. An anatomic study of nasal tip supporting structures. Ann Plast Surg 2004; 52(2):134-9.
Turner F, Zanaret M, Giovanni A. Evaluation of nasal tip projection. Fr ORL 2007; 92:282-7.
Kridel RW, Scott BA, Foda HM. The tongue-in-Groove technique in septorhinoplasty, A 10-Year Experience. Arch Facial Plast Surg 1999; 1(4):246-58.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The copyright on any article published in Zanco J Med Sci is retained by the author(s) in agreement with the Creative Commons Attribution Non-Commercial ShareAlike License (CC BY-NC-SA 4.0).
