Anatomy of the Upper Lateral Cartilage along the Lateral Pyriform Aperture

Craig, John R.; Bied, Adam; Landas, Steve K.; Suryadevara, Amar C.

doi:10.1097/prs.0000000000000918

Cited by 12 publications

(10 citation statements)

References 13 publications

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“…They also added that although the anatomical details of the ULCs are of great importance for the maintenance or even the creation of an aesthetically pleasing dorsum with proper respiratory function, the literature includes few studies related to these themes. Crag et al [7] observed that the ULC articulates laterally with the frontal process of the maxilla by means of the pyriform ligament with a variable amount of overlap between the ULC and maxilla. Rohrich and Ghavami [23] on their study on Middle Eastern noses found that the lower lateral, middle and medial crural cartilages are often weak and thin relative to the heavy skin and soft tissue sleeve.…”

Section: Introductionmentioning

confidence: 99%

Morphological and morphometric study of the cartilaginous framework of the dorsum and tip of the nose among Egyptian populations: a cadaveric study

El-Shaarawy

2016

Folia Morphol

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Section: Introductionmentioning

confidence: 99%

Morphological and morphometric study of the cartilaginous framework of the dorsum and tip of the nose among Egyptian populations: a cadaveric study

El-Shaarawy

2016

Folia Morphol

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“…17 The extensive nature of these fibrous attachments illustrates their important contributions to the ala as well as their functional support of the tip and middle vault. Craig and colleagues 18 showed that the upper lateral cartilages have dense, fibrous attachments to the lateral pyriform aperture. In addition, histological analyses have revealed that the lateral aspects of the upper lateral cartilages lie deep in the frontal process of the maxilla, with a variable degree of distance between the 2.…”

Section: Discussionmentioning

confidence: 99%

“…4,8,19 Even the lateral soft tissue can fall victim to these stresses and, without adequate structural support, can lead to internal nasal valve collapse. 8,18 This outcome underscores the need to evaluate not only the defect location and size but also the extent of tissue elevation required for reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Comparative Study of Functional Nasal Reconstruction Using Structural Reinforcement

Ezzat

Liu

2017

JAMA Facial Plast Surg

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IMPORTANCE Nasal reconstruction after Mohs surgery is a unique challenge in that it must satisfy both functional and aesthetic goals. Despite some advocacy in the literature for using structural reinforcement to achieve both functional and aesthetic outcomes in soft-tissue reconstruction, no study has validated this claim by comparing reconstruction with and without structural support. OBJECTIVE To evaluate the effectiveness of and need for structural reinforcement when reconstructing the nasal alar and sidewall subunits. DESIGN, SETTING, AND PARTICIPANTS This study was a retrospective review of the medical records of 190 patients 18 years or older who underwent nasal reconstruction after Mohs surgery in a tertiary care academic center between January 1, 2013, and August 31, 2015. Data on each patient included demographics, comorbidities, smoking status, details of the lesion, size of defect, subunits involved, and reconstructive technique. Patients were divided into 2 cohorts composed of those who had reconstruction with structural reinforcement (ie, cartilage grafting or suspension suture) and those with only soft-tissue reconstruction. Patients with nasal obstruction from the functional collapse of the reconstructed area and no history of nasal obstruction were included (n = 38). Patients who had a follow-up of less than 2 months, no alar or sidewall involvement, nasal obstruction secondary to turbinate hypertrophy, septal deflection or other nonstructural causes, and incomplete documentation for analysis were excluded (n = 102). MAIN OUTCOMES AND MEASURES Rates of postoperative nasal obstruction secondary to nasal sidewall collapse and need for revision surgery. RESULTS Of the 38 patients who met the inclusion criteria, 22 were men and 16 were women with a mean (range) age of 64.5 (35-92) years. Twenty-three patients (61%) underwent reconstruction by a facial plastic surgeon and 15 (39%) by 2 dermatologic surgeons. Three (8%) underwent reconstruction without reinforcement and experienced postoperative nasal obstruction. The mean size of reconstructed defects that resulted in nasal valve collapse was 2.1 cm in diameter (range, 1.2-2.6 cm). Defect size was associated with incidence of postoperative nasal obstruction. For defects greater than 1.2 cm in diameter, patients reconstructed without reinforcement had a statistically significant increase of nasal obstruction secondary to functional nasal collapse compared with patients reconstructed with reinforcement (3 of 14 [21%] vs 0 of 17; 95% CI, 0.005-0.358; P = .04). CONCLUSIONS AND RELEVANCE Nasal defects greater than 1.2 cm in diameter and involving the alar and sidewalls were associated with lower incidence of postoperative nasal obstruction when a structural reinforcement technique was used in reconstruction. The findings of this study support the structural reinforcement of the nasal functional subunits during Mohs reconstructive surgery to achieve optimal outcomes. LEVEL OF EVIDENCE 3.

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“…Lateral fibrous attachment of the upper lateral cartilages to the frontal process of the maxilla occurs via bony overlap or close approximation with histological evidence of a pyriform ligament of fused perichondrium with periosteum. 15 Lower pyriform aperture recession contributes not only to an apparent dorsal hump, but also to potential internal nasal valve collapse due to pyriform ligament support loss. The attachments of the upper and lower lateral cartilages at the "scroll" region are composed of unidirectional collagen fibers that are prone to separation and distortion via the forces of facial mimetic muscle movement and the downward force of gravity over time.…”

Section: Bony Facial Skeletonmentioning

confidence: 99%

“…In the ptotic nasal tip, it may be necessary to perform a lateral crural overlay technique where the lateral crura are divided laterally and overlapped to shorten the lateral crural limbs of the tripod complex (►Figs. [15][16][17][18]. This will result in increased nasal tip rotation and shortening of the nose.…”

Section: Managing the Nasal Tipmentioning

confidence: 99%

Rhinoplasty of the Aging Nose

Toriumi

Rosenberger

2016

Facial plast Surg

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The process of aging leads to countless bodily changes on both a macro- and microscopic scale. No organ system is unaffected; however, the nose is especially susceptible. Sun damage, hormone levels, regenerative capability, tissue elasticity, bone resorption, and the effects of gravity contribute to produce classic signs and symptoms. Rhinoplasty of the aging nose requires a comprehensive understanding of aging facial anatomy combined with surgical techniques designed to resist these ubiquitous remodeling forces over time.

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Anatomy of the Upper Lateral Cartilage along the Lateral Pyriform Aperture

Cited by 12 publications

References 13 publications

Morphological and morphometric study of the cartilaginous framework of the dorsum and tip of the nose among Egyptian populations: a cadaveric study

Morphological and morphometric study of the cartilaginous framework of the dorsum and tip of the nose among Egyptian populations: a cadaveric study

Comparative Study of Functional Nasal Reconstruction Using Structural Reinforcement

Rhinoplasty of the Aging Nose

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