Patient Outcomes in Lateral Crural Repositioning and Reconstruction in Revision Rhinoplasty

Abstract

Background:

In revision rhinoplasty, lateral crural repositioning/reconstruction is considered a complex maneuver. The aim of this study is to measure patient outcomes after lateral crural repositioning/reconstruction in revision rhinoplasty.

Methods:

In this retrospective case series, patients who underwent revision rhinoplasty with lateral crural repositioning/reconstruction for functional, cosmetic, or combined purposes were reviewed. Preoperative Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) scores, functional and cosmetic visual analog scales (VAS-functional [F] and VAS-cosmetic [C]), and lateral wall insufficiency (LWI) grades were compared with their respective postoperative scores.

Results:

Forty-two patients were identified who underwent lateral crural repositioning. The mean postoperative follow-up for ≤6 months (PO1) and >6 months (PO2) was 3.1 (standard deviation [SD] 1.7) and 11.5 (SD 5.3) months, respectively. At both postoperative periods, significant improvement (p < 0.05) in patient-reported outcomes was observed in mean SCHNOS-Obstruction, SCHNOS-Cosmesis, VAS-F, and VAS-C scores. The postoperative changes in LWI scores (Δ) were significant on both sides at zone 1 at PO1 (p < 0.05) and PO2 (p < 0.05), and at PO2 on the left side (p < 0.05) only, for zone 2.

Conclusion:

Lateral crural repositioning with reconstruction is an effective maneuver in revision rhinoplasty in a subset of patients and specifically helps to improve nasal tip aesthetics while preserving function.

Get full access to this article

View all access options for this article.

References

Sheen

. Secondary rhinoplasty. Plast Reconstr Surg. 1975; 56:137–145.

Gunter

, Rohrich

. External approach for secondary rhinoplasty. Plast Reconstr Surg. 1987; 80:161–174.

Hamra

. Repositioning the lateral alar crus. Plast Reconstr Surg. 1993; 92(7):1244–1253.

Gunter

, Friedman

. Lateral crural strut graft: technique and clinical applications in rhinoplasty. Plast Reconstr Surg. 1997; 99:943–952; discussion 953–945.

Toriumi

, Asher

. Lateral crural repositioning for treatment of cephalic malposition. Facial Plast Surg Clin North Am. 2015; 23:55–71.

Cochran

, Sieber

. Extended alar contour grafts: an evolution of the lateral crural strut graft technique in rhinoplasty. Plast Reconstr Surg. 2017; 140:559e–567e.

Abdelwahab

, Patel

, Kandathil

, et al. Effect of lateral crural procedures on nasal wall stability and tip aesthetics in rhinoplasty. Laryngoscope. 2021; 131:E1830–E1837.

Abdelwahab

, Most

. The miniature lateral crural strut graft: efficacy of a novel technique in tip plasty. Laryngoscope. 2020; 130:2581–2588.

Ali-Salaam

, Kashgarian

, Davila

, et al. Anatomy of the Caucasian alar groove. Plast Reconstr Surg. 2002; 110:261–266; discussion 267–271.

10.

Ilhan

, Saribas

, Caypinar

. Aesthetic and functional results of lateral crural repositioning. JAMA Facial Plast Surg. 2015; 17:286–292.

11.

Sheen

. Aesthetic Rhinoplasty. St. Louis, MO: Mosby-Year Book, Inc.; 1978.

12.

Sheen

JH.

Malposition of alar cartilages. Presented at: Annual Meeting of American Society of Aesthetic Plastic Surgery, Los Angeles, CA; 1992.

13.

Most

, Moubayed

. Patient-reported outcome measures for facial plastic surgery: a specialty finally gets to go to the PROM. JAMA Facial Plast Surg. 2017; 19:101.

14.

Moubayed

, Ioannidis

JPA

, Saltychev

, et al. The 10-item standardized cosmesis and health nasal outcomes survey (SCHNOS) for functional and cosmetic rhinoplasty. JAMA Facial Plast Surg. 2018; 20:37–42.

15.

Vaezeafshar

, Moubayed

, Most

. Repair of lateral wall insufficiency. JAMA Facial Plast Surg. 2018; 1;20(2):111–115.

16.

Kandathil

, Saltychev

, Abdelwahab

, Spataro

, Moubayed

, Most

. Minimal clinically important difference of the standardized cosmesis and health nasal outcomes survey. Aesthet Surg J. 2019; 39(8):837–840.

17.

Bared

, Rashan

, Caughlin

, Toriumi

. Lower lateral cartilage repositioning: objective analysis using 3-dimensional imaging. JAMA Facial Plast Surg. 2014; 16(4):261–267.

18.

Hamilton GS 3rd. Form and function of the nasal tip: reorienting and reshaping the lateral crus. Facial Plast Surg. 2016; 32(1):49–58

19.

Hafezi

, Naghibzadeh

, Kazemi Ashtiani

. Lower lateral cartilage cephalic malposition: an over-diagnosed entity. Aesthetic Plast Surg. 2018; 42(3):867–876.

20.

Constantian

. The boxy nasal tip, the ball tip, and alar cartilage malposition: variations on a theme—a study in 200 consecutive primary and secondary rhinoplasty patients. Plast Reconstr Surg. 2005; 116(1):268–281.

21.

Sheen

, Sheen

. Aesthetic Rhinoplasty, 2nd ed. St. Louis, MO: Mosby; 1987.

22.

Murakami

, Barrera

, Most

. Preserving structural integrity of the alar cartilage in aesthetic rhinoplasty using a cephalic turn-in flap. Arch Facial Plast Surg. 2009; 11:126–128.

23.

Toriumi

. New concepts in nasal tip contouring. Arch Facial Plast Surg. 2006; 8:156–185.

24.

Surowitz

, Most

. Complications of rhinoplasty. Facial Plast Surg Clin North Am. 2013; 21:639–651.

25.

Most

. Trends in functional rhinoplasty. Arch Facial Plast Surg. 2008; 10:410–413.

26.

Tsao

, Fijalkowski

, Most

. Validation of a grading system for lateral nasal wall insufficiency. Allergy Rhinol (Providence). 2013; 4:e66–e68.

27.

Sepehr

, Alexander

, Chauhan

, Chan

, Adamson

. Cephalic positioning of the lateral crura: implications for nasal tip-plasty. Arch Facial Plast Surg. 2010; 12(6):379–384.

28.

Paquet

, Choroomi

, Frankel

. An analysis of lateral crural repositioning and its effect on alar rim position. JAMA Facial Plast Surg. 2016; 18(2):89–94.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.18 MB