Preserving Structural Integrity of the Alar Cartilage in Aesthetic Rhinoplasty Using a Cephalic Turn-in Flap

Murakami, Craig S.; Barrera, José E.; Most, Sam P.

doi:10.1001/archfacial.2008.524

Cited by 43 publications

(39 citation statements)

References 5 publications

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“…There is no way to isolate the effects of the interventions described, and it is highly likely that the surgical maneuvers affect components of both the internal and external valve. Murakami et al 17 described the cephalic turn-in flap technique, and the need to combine this technique with other maneuvers, such as spreader grafts, has been emphasized by surgeons. 18 Multiple maneuvers is commonplace in rhinoplasty surgery, as patients, especially those undergoing revision, present with a number of problems, and more than 1 surgical technique is applied.…”

Section: Discussionmentioning

confidence: 99%

Costal Cartilage Lateral Crural Strut Graft vs Cephalic Crural Turn-in for Correction of External Valve Dysfunction

Barham

Knisely

Christensen

et al. 2015

JAMA Facial Plast Surg

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IMPORTANCE External nasal valve dysfunction (EVD) is a common cause of nasal obstruction.OBJECTIVE To evaluate costal cartilage lateral crural strut grafts vs cephalic crural turn-in to support the weak lateral crus in patients with EVD. DESIGN, SETTING, AND PARTICIPANTSIn this prospective cohort study, patients with clinically diagnosed EVD were assessed at the Tertiary Rhinologic Center and underwent a costal cartilage underlay graft to the lateral crus or a cephalic turn-in cruralplasty. MAIN OUTCOMES AND MEASURES Assessment of patient benefit was based on 22-Item Sinonasal Outcome Test (SNOT-22) and Nasal Obstruction Symptom Evaluation Scale (NOSE) scores. A Likert scale was also used to assess overall function and cosmesis. Objective assessment included postdecongestion nasal peak inspiratory flow, nasal airway resistance, and minimum cross-sectional area. RESULTS Forty-one patients (mean [SD] 35.38 [12.73] years of age; 25 [61%] female) were assessed. Cephalic turn-in maneuver was used for 25 (61%) patients; costal cartilage lateral crural strut grafts, 16 (39%) patients. Costal cartilage grafts were used in patients undergoing revision but other baseline data were similar. Follow-up was mean 10.58 (7.52) months. All patients had significantly improved visual analog scale, SNOT-22, NOSE, patient-reported function, and cosmesis scores. The only objective test that improved was nasal peak inspiratory flow (114.76 [60.48] L/min vs 126.46 [61.17] L/min; P = .02). CONCLUSIONS AND RELEVANCE Both techniques were effective in improving patient-reported outcomes and nasal peak inspiratory flow. Both are functionally and cosmetically viable options for correction of EVD. LEVEL OF EVIDENCE 2.

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Section: Discussionmentioning

confidence: 99%

Costal Cartilage Lateral Crural Strut Graft vs Cephalic Crural Turn-in for Correction of External Valve Dysfunction

Barham

Knisely

Christensen

et al. 2015

JAMA Facial Plast Surg

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“…However, any technique that changes the nasal tip cartilage may affect the NVA and subsequently nasal air flow. The modern approach to functional rhinoplasty recognizes the importance of the tip framework's structural integrity and preserves tip support [8,9]. Primary tip support is manifested by the structural integrity and uninterrupted uniformity of the LLC.…”

Section: Discussionmentioning

confidence: 99%

Preservation of the Nasal Valve Area With a Lateral Crural Hinged Flap: A Cadaveric Study

2011

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“…In addition, it provides aesthetic nasal tip improvements by medialization of the tipdefining points and increases a visual gain in tip position without functional impairments as successfully as cephalic excision. 7,8 Objective evaluations of the outcomes of this technique revealed that it increased tip rotation but decreased tip projection. This result is very consistent with the tripod theory.…”

Section: Commentmentioning

confidence: 99%

“…Resection of this part permits medialization of the tipdefining points and increases a visual gain in tip position. 7,8 Weakness of the LC during various techniques for the correction of tip deformities may cause a concave alar rim and even external nasal valve collapse. The structure and support of the alar cartilage may not seem compromised at first, but long-term stability as a result of contractile forces may cause weak cartilages to be at risk.…”

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confidence: 99%

Lateral Crural Setback With Cephalic Turn-in Flap

Sazgar¹

2010

Arch Facial Plast Surg

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Herein, I describe lateral crural setback with cephalic turn-in flap as a new technique for management of the drooping nose. I report a technique for reinforcement of the alar cartilage after partial removal of its caudal portion used in 23 patients during open rhinoplasty. An objective assessment, which included measurement of nasal tip rotation and projection, was applied preoperatively and postoperatively. The average follow-up period was 11 months. Satisfactory results were achieved that resulted in an increase in the degree of nasal tip rotation. The mean increase of the nasolabial angle was 12°. This technique allows increasing the nasal tip rotation in an incremental fashion with preservation of nasal valve function and the strength and stability of the tip complex.

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Preserving Structural Integrity of the Alar Cartilage in Aesthetic Rhinoplasty Using a Cephalic Turn-in Flap

Cited by 43 publications

References 5 publications

Costal Cartilage Lateral Crural Strut Graft vs Cephalic Crural Turn-in for Correction of External Valve Dysfunction

Costal Cartilage Lateral Crural Strut Graft vs Cephalic Crural Turn-in for Correction of External Valve Dysfunction

Preservation of the Nasal Valve Area With a Lateral Crural Hinged Flap: A Cadaveric Study

Lateral Crural Setback With Cephalic Turn-in Flap

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