Aesthetic and Functional Results of Lateral Crural Repositioning

Abstract

IMPORTANCE Thin or cephalically malpositioned lateral crura cause nasal obstruction by depressing nasal valves and decrease patient satisfaction with rhinoplasty as a result of nostril asymmetry and alar collapse.OBJECTIVE To demonstrate the aesthetic and functional efficacy of lateral crural repositioning with lateral strut grafting in patients with cephalic malposition of the lateral crura undergoing primary septorhinoplasty. DESIGN, SETTING, AND PARTICIPANTSWe prospectively selected 80 patients with lateral crural malposition who underwent primary septorhinoplasty performed by the same surgeon from December 1, 2013, through May 30, 2014. The surgeon measured the angle between the lateral crura and midline intraoperatively with a goniometer to confirm malposition (angle, Յ30°). Data analysis was performed from March 13 to 23, 2015. INTERVENTION All the patients underwent primary rhinoplasty with the open approach. Lateral crural repositioning with lateral crural strut graft was used in all selected patients. MAIN OUTCOME AND MEASURES Preoperative and 6-and approximately 12-month postoperative scores on the Nasal Obstruction Symptom Evaluation (NOSE) scale (range, 0-20; decreased scores indicate improved functional results) and the Rhinoplasty Outcomes Evaluation (ROE) questionnaire (range, 0-24; increased scores indicate improved aesthetic results).RESULTS Seventy-five of 80 patients were confirmed to have cephalic malposition intraoperatively. Four patients were excluded owing to selection of different surgical techniques, leaving 71 patients for analysis. The mean (SD) and median postoperative NOSE scores at 6 months (3.18 [3.12] and 2.0) and 12 months (0.39 [1.07] and 0) showed significant improvement compared with the preoperative scores (6.96 [5.10] and 7.0) (P < .01 for each comparison). The mean (SD) and median postoperative ROE scores also showed significant improvement at 6 months (21.06 [3.82] and 23.0) and 12 months (23.12 [2.09] and 24.0) compared with preoperative scores (7.03 [3.70] and 6.0) (P = .001). However, the changes from preoperative to 12-month postoperative scores (mean [SD] and median) were not significantly different between patients with normal (NOSE scores, 8.41 [4.59] and 90 to 0.28 [0.79] and 0, respectively; ROE scores, 6.97 [3.24] and 6.0 to 23.31 [1.91] and 24.0, respectively) and thin (NOSE score, 6.59 [5.09] and 8.0 to 0.11 [0.33] and 0, respectively; ROE scores, 7.76 [3.82] and 7.0 to 23.29 [1.72] and 24.0, respectively) skin types and those with thick skin types (NOSE scores, 5.52 [5.42] and 4.0 to 0.72 [1.54] and 0, respectively; ROE scores, 6.60 [4.16] and 6.0 to 22.80 [2.53] and 24.0, respectively) (P > .05).CONCLUSIONS AND RELEVANCE Lateral crural repositioning is a useful and versatile technique to achieve successful functional and aesthetic results in a 1-year follow-up. We detected no significant difference by skin type in improvement of nasal function and aesthetic satisfaction.LEVEL OF EVIDENCE 3.

Association of Skin Thickness With Alar Base Reduction in Patients Undergoing Lateral Crural Repositioning and Strut Grafting

“…An angle of 30°or less between the caudal edge of the lateral crura and the midline of the dorsum as measured by a gonioscope was considered cephalic malposition ( Figures 1, 2, 3, and 4). 4 Patients with such malposition underwent LCrep with LCSG. 5 Afterward, tip sutures and columellar supporting grafts appropriate for the patient (tongue-in-groove or columellar strut) and cap grafts were applied to increase tip definition.…”

Nasal obstruction symptom evaluation (NOSE) score outcomes after septorhinoplasty

“…However, the ideal follow‐up duration after functional septorhinoplasty has not yet been determined. Previous literature utilizing NOSE scores report variable follow‐up, ranging from 1 month to 4 years …”

A Comprehensive Quality-of-Life Instrument for Aesthetic and Functional Rhinoplasty

“…The NOSE scale has been much more widely adopted than the ROE instrument, though use of the ROE is increasingly as evidenced in several recent outcomes studies. 10 – 12 As a consequence, we have much more data regarding outcomes with regard to function and little with regard to aesthetics. Likewise, we have even fewer examples of concurrent study of both.…”