Advertisement

Aesthetic Plastic Surgery

, Volume 43, Issue 1, pp 175–183 | Cite as

The Relation Between the Lower Lateral Cartilages and the Function of the External Nasal Valve

  • Eduardo Nascimento SilvaEmail author
Original Article Rhinoplasty
  • 176 Downloads

Abstract

Introduction

The position of the lower lateral cartilages (LLC) is closely related to the function of the external nasal valve (ENV). When there is a cephalic malposition of these cartilages, the nasal alae have inadequate support, which leads to ENV insufficiency during deep inspiration.

Methods

Retrospective study with 60 patients evaluated: the positioning of the LLC and the occurrence of ENV insufficiency; the effectiveness of structuring the medial and lateral walls of the ENV; and the frequency of the grafts used for structuring it.

Results

Of the 60 operated cases, 37 patients (62%) had ENV insufficiency, in 23 cases there was cephalic malposition of the LLC, and in the latter group 17 patients (74%) presented this insufficiency. A structured ENV was effective in the treatment of this insufficiency (p = 0.001). A lateral crural strut graft was performed in 24 cases (40%) of 60 patients operated. The alar contour graft was performed from 2013 to 2015 in 4 patients (22%) of 18 cases operated, and between 2016 and 2018 it was performed in 29 patients (69%) out of 42 cases. The columellar strut was routinely used from 2013 to mid-2016 in 33 cases (100%), and after that period until the present day the tongue-in-groove technique was performed in 11 cases (41%) and in the remaining 16 cases (59%) the caudal septal extension graft was performed.

Conclusion

Cephalic malposition of the LLC is an important red flag of ENV insufficiency. This insufficiency should be treated by structuring the walls of the ENV.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Keywords

Nose Nasal cartilage Nasal obstruction Rhinoplasty 

Notes

Acknowledgements

The author declares that he has no conflict of interest to disclose.

Supplementary material

266_2018_1195_MOESM1_ESM.mp4 (9.4 mb)
Video 1: Evaluation of nasal alae collapse during deep inspiration. Pre- and 1.5 year postoperative (MP4 9631 kb)

References

  1. 1.
    Howard BK, Rohrich RJ (2002) Understanding the nasal airway: principles and practice. Plast Reconstr Surg 109(3):1128–1144Google Scholar
  2. 2.
    Teichgraeber JF, Wainwright DJ (1994) The treatment of nasal valve obstruction. Plast Reconstr Surg 93(6):1174–1182Google Scholar
  3. 3.
    Constantian MB (1994) The incompetent external nasal valve: pathophysiology and treatment in primary and secondary rhinoplasty. Plast Reconstr Surg 93(5):919–931Google Scholar
  4. 4.
    Constantian MB, Clardy RB (1996) The relative importance of septal and nasal valvular surgery in correcting airway obstruction in primary and secondary rhinoplasty. Plast Reconstr Surg 98(1):38–54Google Scholar
  5. 5.
    Gunter JP, Friedman RM (1997) Lateral crural strut graft: technique and clinical applications in rhinoplasty. Plast Reconstr Surg 99(4):943–952Google Scholar
  6. 6.
    Constantian MB (2000) Four common anatomic variants that predispose to unfavorable rhinoplasty results: a study based on 150 consecutive secondary rhinoplasties. Plast Reconstr Surg 105(1):316–331Google Scholar
  7. 7.
    Constantian MB (2004) The two essential elements for planning tip surgery in primary and secondary rhinoplasty: observations based on review of 100 consecutive patients. Plast Reconstr Surg 114(6):1571–1581Google Scholar
  8. 8.
    Constantian MB (2005) 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 116(1):268–281Google Scholar
  9. 9.
    Silva EN, Bittencourt RC (2017) Preoperative and postoperative assessment of external nasal valve in rhinoplasty. Rev Bras Cir Plást 32(1):17–27Google Scholar
  10. 10.
    Toriumi DM, Asher SA (2015) Lateral crural repositioning for treatment of cephalic malposition. Facial Plast Surg Clin N Am 23(1):55–71Google Scholar
  11. 11.
    Sheen JH (1978) Aesthetic rhinoplasty, 1st edn. Mosby, St. Louis, pp 432–462Google Scholar
  12. 12.
    Rohrich RJ, Raniere J Jr, Ha RY (2002) The alar contour graft: correction and prevention of alar rim deformities in rhinoplasty. Plast Reconstr Surg 109(7):2495–2505Google Scholar
  13. 13.
    Toriumi DM (2006) New concepts in nasal tip contouring. Arch Facial Plast Surg 8(3):156–185Google Scholar
  14. 14.
    Bared A, Rashan A, Caughlin BP, Toriumi DM (2014) Lower lateral cartilage repositioning: objective analysis using 3-dimensional imaging. JAMA Facial Plast Surg 16(4):261–267Google Scholar
  15. 15.
    Rhee JS, Arganbright JM, McMullin BT, Hannley M (2008) Evidence supporting functional rhinoplasty or nasal valve repair: a 25-year systematic review. Otolaryngol Head Neck Surg 139(1):10–20Google Scholar
  16. 16.
    Hamra ST (1993) Repositioning the lateral alar crus. Plast Reconstr Surg 92(7):1244–1253Google Scholar
  17. 17.
    Webster RC, Smith RC (1979) Lateral crural retrodisplacement for superior rotation of the tip in rhinoplasty. Aesthetic Plast Surg 3(1):65–78Google Scholar
  18. 18.
    Daniel RK (1992) The nasal tip: anatomy and aesthetics. Plast Reconstr Surg 89(2):216–224Google Scholar
  19. 19.
    Silva EN, Ribeiro AL, Santos GC, Roceto JHM, Medeiros NB, Kuchler S, Pizato VA (2015) Applied anatomy of nasal tip in rhinoplasty. Rev Méd Paraná 73(1):29–33Google Scholar
  20. 20.
    Toriumi DM, Josen J, Weinberger M, Tardy ME Jr (1997) Use of alar batten grafts for correction of nasal valve collapse. Arch Otolaryngol Head Neck Surg 123(8):802–888Google Scholar
  21. 21.
    Gruber RP (2002) Discussion: the alar contour graft: correction and prevention of alar rim deformities in rhinoplasty. Plast Reconstr Surg 109(7):2506–2508Google Scholar
  22. 22.
    Gubisch W, Eichhorn-Sens J (2009) Overresection of the lower lateral cartilages: a common conceptual mistake with functional and aesthetic consequences. Aesthetic Plast Surg 33(1):6–13Google Scholar
  23. 23.
    Ponsky D, Eshraghi Y, Guyuron B (2010) The frequency of surgical maneuvers during open rhinoplasty. Plast Reconstr Surg 126(1):240–244Google Scholar
  24. 24.
    Silva EN, Ribas-Filho JM (2014) External nasal valve insufficiency: planning and performing. Rev Méd Paraná 72(1):20–23Google Scholar
  25. 25.
    Toriumi DM (2002) Structure approach in rhinoplasty. Facial Plast Surg Clin N Am 10(1):1–22Google Scholar
  26. 26.
    Swartout B, Toriumi DM (2007) Rhinoplasty. Curr Opin Otolaryngol Head Neck Surg 15(4):219–227Google Scholar
  27. 27.
    Kridel RW, Scott BA, Foda HM (1999) The tongue-in-groove technique in septorhinoplasty. A 10-year experience. Arch Facial Plast Surg 1(4):246–258Google Scholar
  28. 28.
    Shah A, Pfaff M, Kinsman G, Steinbacher DM (2015) Alar-columellar and lateral nostril changes following tongue-in-groove rhinoplasty. Aesthetic Plast Surg 39(2):191–198Google Scholar
  29. 29.
    Datema FR, Lohuis PJ (2015) Tongue-in-groove setback of the medial crura to control nasal tip deprojection in open rhinoplasty. Aesthetic Plast Surg 39(1):53–62Google Scholar
  30. 30.
    Datema FR, Lohuis PJ (2016) The tongue-in-groove technique in primary and revision rhinoplasty. Facial Plast Surg 32(4):416–423Google Scholar
  31. 31.
    Antunes MB, Quatela VC (2018) Effects of the tongue-in-groove maneuver on nasal tip rotation. Aesthet Surg J 1:9Google Scholar
  32. 32.
    Toriumi DM (1995) Caudal septal extension graft for correction of retracted columella. Oper Tech Otolaryngol 6(4):311–318Google Scholar
  33. 33.
    Gunter JP, Landecker A, Cochran CS (2006) Frequently used grafts in rhinoplasty: nomenclature and analysis. Plast Reconstr Surg 118(1):14e–29eGoogle Scholar
  34. 34.
    Toriumi DM, Patel DM, DeRosa J (2006) Correcting the short nose in revision rhinoplasty. Facial Plast Surg Clin N Am 14(4):343–355Google Scholar
  35. 35.
    Toriumi DM, Bared A (2012) Revision of the surgically overshortened nose. Facial Plast Surg 28(4):407–416Google Scholar
  36. 36.
    Guyuron B (2001) Alar rim deformities. Plast Reconstr Surg 3:856–863Google Scholar
  37. 37.
    Guyuron B, Sajjadian YBA (2015) Dynamics of the alar rim graft. Plast Reconstr Surg 135(4):981–986Google Scholar
  38. 38.
    Unger JG, Roostaeian J, Small KH, Pezeshk RA, Lee MR, Harris R, Rohrich RJ (2016) Alar contour grafts in rhinoplasty: a safe and reproducible way to refine alar contour aesthetics. Plast Reconstr Surg 137(1):52–61Google Scholar
  39. 39.
    Cochran CS, Sieber DA (2017) Extended alar contour grafts: an evolution of the lateral crural strut graft technique in rhinoplasty. Plast Reconstr Surg 140(4):559e–567eGoogle Scholar
  40. 40.
    Vaezeafshar R, Moubayed SP, Most SP (2018) Repair of lateral wall insufficiency. JAMA Facial Plast Surg 20(2):111–115Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2018

Authors and Affiliations

  1. 1.Medicine DepartmentState University of Ponta GrossaPonta GrossaBrazil
  2. 2.Ponta GrossaBrazil

Personalised recommendations