Cephalic Positioning of the Lateral Crura

Sepehr, Ali; Alexander, Ashlin J.; Chauhan, Nitin; Chan, Harley; Adamson, Peter A.

doi:10.1001/archfacial.2010.87

Cited by 23 publications

(21 citation statements)

References 16 publications

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“…18 We also found that repositioning and an LCSG in patients with cephalic malposition support the nasal valve and positively affect the postoperative aesthetic results, as has been reported in previous studies. 5,14,18 Statistically significant decreases in NOSE scale scores and increases in ROE scores postoperatively demonstrated improvement in function and aesthetic satisfaction. Skin thickness and elasticity are the most important factors that affect the overall satisfaction of patients undergoing rhinoplasty.…”

Section: Discussionmentioning

confidence: 98%

“…He concluded that malposition caused boxy and bulbous tip deformities and functional deficits according to the results of the rhinomanometry measurements obtained from the groups undergoing primary and secondary rhinoplasty. 10 According to Sepehr et al, 5 cephalic malpositioning affected tip shape by altering the projection, rotation, and lateral crura length in patients with parenthesis tip deformity and requires the use of different tipplasty techniques for correction. We deduced that we can achieve the needed rotation and deprojection more easily with the "sliding in" effect of the whole tip complex by lateral crural repositioning and LCSG with the combination of selected tip-plasty maneuvers.…”

Section: Discussionmentioning

confidence: 99%

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Aesthetic and Functional Results of Lateral Crural Repositioning

İlhan¹,

Saribas²,

Caypinar³

2015

JAMA Facial Plast Surg

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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.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Aesthetic and Functional Results of Lateral Crural Repositioning

İlhan¹,

Saribas²,

Caypinar³

2015

JAMA Facial Plast Surg

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“…In addition, patients with cephalically oriented cartilages were identified on preoperative photography based on the presence of lower lateral cartilages that were aligned with the medial canthus rather than the lateral canthus. 9,10 Statistical analysis involved a 1-tailed t test comparing preoperative and postoperative values.…”

Section: Methodsmentioning

confidence: 99%

Alar Retraction

Alexander

Shah

Constantinides

2013

JAMA Facial Plast Surg

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The effect of different rhinoplasty maneuvers on alar retraction remains to be elucidated.OBJECTIVE To determine the etiology and treatment of alar retraction based on a series of specific rhinoplasty maneuvers.DESIGN Retrospective review of a single surgeon's rhinoplasty digital photo database, examining preoperative alar retraction from January 1, 2002, to December 31, 2005, in 520 patients. Patients with more than 1 mm of alar retraction on preoperative photographs were identified. Postoperative photographs were examined to determine the effect of specific rhinoplasty maneuvers on the position of the alar margin; these maneuvers included cephalic trim, cephalic positioning of the lower lateral cartilage, composite grafts, alar rim grafts, alar batten grafts, and overlay of the lower lateral cartilage.SETTING Tertiary care academic health center.PARTICIPANTS Forty-five patients with alar retraction met inclusion criteria, resulting in 63 nasal halves with alar retraction. MAIN OUTCOMES AND MEASURES Intraoperative findings, postoperative results.RESULTS Forty-seven percent of the patients (n = 21) had prior surgery; 47% also had cephalically positioned lower lateral cartilages. Among patients with less than 4 mm of cartilage width at the outset, 46% of those who received supportive grafts achieved target correction vs only 7% for patients who did not undergo supportive cartilage grafting. In patients who underwent more than 4 mm of cephalic trim, those who received supportive grafts achieved 46% of target correction vs 11% among those who did not. Ninety-five percent of composite grafts, 69% of alar strut grafts, 47% of alar rim grafts, 43% of vertical lobule division, and 12% of alar batten grafts achieved their target correction values.CONCLUSIONS AND RELEVANCE Alar retraction is a highly complex problem. It can be seen de novo and is associated with cephalically positioned lower lateral cartilages. Structurally supportive grafting-including composite grafts, alar strut grafts, alar rim grafts, vertical lobule division, and alar batten grafts-can improve alar retraction.LEVEL OF EVIDENCE 4.

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“…Specifically, cephalically positioned lateral crura (as compared with orthotopic lateral crura) affect the results of the various tipplasty maneuvers, including changes in projection, rotation, and nasal length. Sepehr et al 12 concluded that the cephalically positioned lateral crura can affect the results of various tip-plasty surgical maneuvers, at least as measured geometrically in a computer model. Nasal tip refinement is one of the more common and challenging goals in rhinoplasty, especially in creating a natural-appearing tip, because this procedure is complex and 3-dimensional.…”

Section: Cephalic Malpositioning Of Lower Lateral Cartilages and Nasamentioning

confidence: 99%

Contemporary Review of Rhinoplasty

Angelos¹,

Been²,

Toriumi³

2012

Arch Facial Plast Surg

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e conducted a contemporary review covering advances and trends in primary and functional rhinoplasty as published during the past decade. Specifically, we reviewed studies supporting the evidence for functional rhinoplasty, nasal valve surgery, and septal reconstruction. In addition, key articles discussing cephalic malpositioning of the lower lateral cartilages and tip contouring are reviewed. We also report studies involving lateral osteotomy techniques, computer imaging, and the use of homologous, alloplastic, and absorbable implants. When appropriate, we review outcomes data from key studies because these data are becoming increasingly important for evidence-based medicine, physician grading, and procedure reimbursement. Using evidence-based approaches whenever possible will help to ensure predictable patient outcomes.

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Cephalic Positioning of the Lateral Crura

Cited by 23 publications

References 16 publications

Aesthetic and Functional Results of Lateral Crural Repositioning

Aesthetic and Functional Results of Lateral Crural Repositioning

Alar Retraction

Contemporary Review of Rhinoplasty

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