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Lower Lateral Cartilage Cephalic Malposition: An Over-Diagnosed Entity

  • Original Article
  • Rhinoplasty
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Abstract

Background

Lower lateral cartilage malposition is represented by anterior convexity of the lower lateral cartilage (LLC) dome with posterior pinch, as defined by Sheen and Constantian. This anatomic variation consists of cephalic, or upward and inward, rotation of lateral crura, particularly in bulbous tip patients. In most cases, “bulbous pinch” LLC is positioned toward the medial canthus, not laterally, so it is referred to as cephalic displacement. Accordingly, it is recommended to caudally displace cartilage in the majority of rhinoplasty cases in which variation is seen.

Objectives

The purpose of this paper is to measure the exact angle of lateral crura with fixed reference points on the face.

Methods

We drew and marked LLC contours and vertical/horizontal lines in 40 consecutive rhinoplasty cases. We then divided them into two groups: (1) bulbous pinch and (2) flat LLCs. The right- and left-sided LLC angles to midline and horizontal lines were measured and compared to assess whether there was any significant difference between the two subgroups.

Results

There was no significant difference between the angles of LLC rotation in the bulbous and flat LLCs groups, measured both vertically and horizontally.

Conclusion

Based on our findings, although cephalic malposition of LLCs may be present in some patients but in the majority of cases the etiology of nasal lateral wall pinching is not cephalic displacement of lateral crura but most probably is due, rather, to severe convexity of the posterior and lateral crura. According to our findings, cephalic malposition is an uncommon anatomic variation of LLCs that has been reported at high frequency (60–70% of their rhinoplasty cases). This finding may help to correct this deformity into a normal anatomic configuration.

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References

  1. Sheen JH, Sheen AP (1998) Aesthetic rhinoplasty, vol II, 2nd edn. Quality Medical Publishing Inc, St. Louis, pp 989–992

    Google Scholar 

  2. Constantian MB, Hanover NH (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 116:268–281

    Article  PubMed  CAS  Google Scholar 

  3. McKinney P (2000) Management of the bulbous nose. Plast Reconstr Surg 106:906–917

    Article  PubMed  CAS  Google Scholar 

  4. Rohrich RJ, Adams WP (2001) The boxy nasal tip: classification and management based on alar cartilage suturing techniques. Plast Reconstr Surg 107:1849–1863

    Article  PubMed  CAS  Google Scholar 

  5. Flint PW, Haughey BH, Thomas Robbins K, Regan Thomas J, Niparko JK, Lund VJ, Lesperance MM Cummings otolaryngology—head and neck surgery, 6th edn. ISBN: 0323278205

  6. Hafezi F, Naghibzadeh B, Nouhi AH (2010) Applied anatomy of the nasal lower lateral cartilage: a new finding. Aesthet Plast Surg 34:244–248

    Article  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  8. Toriumi DM, Asher SA (2015) Lateral crural repositioning for treatment of cephalic malposition. Fac Plast Surg Clin N Am 23(1):55–71. https://doi.org/10.1016/j.fsc.2014.09.004

    Article  Google Scholar 

  9. Rohrich RJ, Liu JH (2012) Defining the infratip lobule in rhinoplasty: anatomy, pathogenesis of abnormalities, and correction using an algorithmic approach. Plast Reconstr Surg 130(5):1148–1158

    Article  PubMed  CAS  Google Scholar 

  10. Daniel RK (2004) The two essential elements for planning tip surgery in primary and secondary rhinoplasty: observations based on review of 100 consecutive patients (discussion). Plast Reconstr Surg 114:1582–1585

    Article  Google Scholar 

  11. Çakır B, Doğan T, Öreroğlu AR, Daniel RK (2013) Rhinoplasty: surface aesthetics and surgical techniques. Aesthet Surg J 33(3):363–375

    Article  PubMed  Google Scholar 

  12. Çakır B, Öreroğlu AR, Daniel RK (2014) Surface aesthetics in tip rhinoplasty: a step-by-step guide. Aesthet Surg J 34(6):941–955

    Article  PubMed  Google Scholar 

  13. Gunter JP, Rohrich RJ (1992) Correction of the pinched nasal tip with alar spreader grafts. Plast Reconstr Surg 90:821–829

    Article  PubMed  CAS  Google Scholar 

  14. Gunter JP, Friedman RM (1997) Lateral crural strut graft: technique and clinical applications in rhinoplasty. Plast Reconstr Surg 99:943–952

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Plastic Surgery Department, St. Fatima Hospital, Iran University of Medical Sciences and Burn Research Center, Suit 12, No.33, Asef (Ejazi) St., Zaferanieh, Tehran, Iran

    Farhad Hafezi

  2. Loghman Hakim Hospital, Shahid Beheshty University of Medical Sciences, Tehran, Iran

    Bijan Naghibzadeh

  3. St. Fatima Hospital, Iran University of Medical Sciences, Tehran, Iran

    Abbas Kazemi Ashtiani

Authors
  1. Farhad Hafezi
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  2. Bijan Naghibzadeh
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  3. Abbas Kazemi Ashtiani
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Corresponding author

Correspondence to Farhad Hafezi.

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Hafezi, F., Naghibzadeh, B. & Kazemi Ashtiani, A. Lower Lateral Cartilage Cephalic Malposition: An Over-Diagnosed Entity. Aesth Plast Surg 42, 867–876 (2018). https://doi.org/10.1007/s00266-018-1136-8

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  • DOI: https://doi.org/10.1007/s00266-018-1136-8

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