The Importance of the Upper Lateral Cartilage in Rhinoplasty

Abstract

The upper lateral cartilages are instrumental in obtaining optimal outcomes in aesthetic and functional rhinoplasty. Knowledgeable manipulation of the upper lateral cartilages can take advantage of the crucial malleable parameters of projection, width, nasal dorsal shape, and tip rotation. A lucid understanding of the anatomical intricacies in this portion of the cartilaginous framework permits the surgeon to use their unique characteristics to consistently achieve the desired results.

Evolution of the butterfly graft technique: 15‐year review of 500 cases with expanding indications

“…In patients who have very thin skin and ULCs of adequate palpable strength, the butterfly graft may not be our first choice for treatment of their NVC. Instead, spreader grafts, spreader flaps, flaring sutures or spanning sutures are used in these patients, especially in primary cosmetic cases . However, as has been previously noted, the technique for design and placement of spreader grafts must be meticulous to avoid inadvertent narrowing of the apex of the nasal valve (Fig.…”

Anatomically Based Optimization of Outcomes in Middle Eastern Rhinoplasy

“…Cephalic rotation of the tip and nasal shortening is achieved in extremely thick skin by M-shaped excision of a measurable strip of skin from the nasal vestibule in addition to common procedures known for this purpose. 10 Most of the patients with poor outcomes are those with more severe forms of thicker skin and weaker cartilages and amorphous nose, they were told preoperatively about these inferior results and that surgery will be more nasal volume reduction rather than refinement surgery and they agreed about that. Thick skin has only 1 advantage in rhinoplasty, which is being permissible for fine irregularities in the dorsal framework.…”

Geometric Modeling of the Nasal Valve

“…Rohrich et al have noted empirically that the "length and rigidity of the ULC in relationship to the septum governs the functionality of the valve." 18 Rather than attempting to directly calculate lateral wall collapse, we chose to evaluate the change in CSA from baseline associated with an observed medial collapse of 2 or 4 mm of the lateral wall; additionally, when the shortening of the lateral wall segment due to dorsal reduction is considered, the change in CSA was recalculated based on the anticipated maximal inward deflection. In other words, the transmural pressure gradient necessary to collapse the lateral wall medially by 2 or 4 mm is only able to collapse the sidewall inward a fraction of the prior displacement due to the stiffening effect of being a shorter segment.…”

“…This effect is independent of the presence or absence of a spreader graft, as the spreader graft only extends the supporting element laterally, and while the cantilevered beam is lateralized, its physical attributes are unchanged. Countless surgeons and many authors have pointed out the importance of "strengthening" or "stabilizing" the nasal valve, 2 and some have advocated reattachment of the ULC to the dorsal septum and/or ULC flaring sutures, 8,18 highlighting the importance of lateral wall stability. Alternatively, Sheen 19 described the spreader graft and advocated its use in patients with short nasal bones, thin skin, flaccid ULCs or those disarticulated from the caudal nasal bone.…”

“…We have described features affecting the postoperative patency of the nose from a geometric and mechanical standpoint and found that they correlate with clinical observations. 12,15,18 We believe this is a useful framework within which to consider manipulations of the nasal valve in rhinoplasty.…”