Maintaining nasal tip structure and contour is an important goal during rhinoplasty surgery. Tip deformities can occur due to lateral crura malposition, trauma or sometimes due to excess of lateral crura triming during previous surgeries. The consequences of lateral crura weakness are not only aesthetic but also functional. A weak lateral cartilage may collapse and fail to maintain normal breathing causing a variable degree of external valvular insufficiency. Several techniques have been described to reinforce the lateral crura so shape and function will remain adequate after surgery. The options vary from dissection of the lateral crus, reverse placement of the lateral crura, turn-in flaps, alar rim grafts, underlay or overlay grafts, and perhaps the most reliable one is the lateral crura strut graft. The authors in this article described a variation of this last technique called the sandwiched lateral crural reinforcement (SLCR) graft. It consists of a combination of a lateral crura strut graft plus a turn in flap using the cephalic rim of the cephalic border of the lateral crus. After dissecting a precise pocket for both grafts, they are sutured to the remaining lateral crura. The result is a reinforced and reshaped lower lateral cartilage (LLC). The technique was applied by the senior author in 30 non-consecutive primary open-approach rhinoplasty procedures. Five men and 25 women ranging in age from 22 to 45 years (median 35 years). The indications for the SLCR was 50% for external valve collapse, correction of cephalic malposition in 30% and reinforcement of LLC for tip deformities in 20%. The authors report no graft displacement or tip deformity after a 24 month period. Interesting article showing a combination of LLC grafting techniques to correct and increase the strength of the lateral crura.

The sandwiched lateral crural reinforcement graft: a novel technique for lateral crus reinforcement in rhinoplasty.

Kuran I, Örerog ̆lu AR.


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Felipe Culaciati

Instituto de ORL & Cirugia Plastica Facial, Barcelona, Spain.

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