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Cephalic Malposition of the Lateral Crura and Parenthesis Deformity: A Cadaver Study in Caucasians

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  • Rhinoplasty
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Abstract

Background

Improving the shape and contour of the nasal tip is a major goal in rhinoplasty. Extreme bulbosity and parenthesis deformity of the nasal tip are both frequently encountered. However, the underlying anatomical features that cause this kind of tip deformity are still not fully understood.

Objectives

To evaluate the relation between the shape of the nasal tip and the anatomical position, orientation and shape of the lateral crura of the lower lateral cartilages and to estimate the incidence of cephalic malposition of lateral crura in Caucasian noses.

Materials and Methods

Nineteen Caucasian cadaver noses were studied, and the alar cartilages were measured and evaluated using a standardized method.

Results

Fourteen of the total 38 lateral crura evaluated had cephalic malposition (long axis angle with the midline equal to or less than 30°). Of the nasal tips classified as having parenthesis deformity, 84.6% had cephalic malposition of lateral crura and 46.2% had convex lateral crura. Vertical orientation of the short axis of the lateral crura was no more common in noses with parenthesis deformity of the nasal tip than in other kinds of nasal tip.

Conclusions

The incidence of cephalic malposition of the lateral crura in this series of Caucasian noses was 36.8%. There was a statistically significant association between parenthesis deformity of the nasal tip and cephalic malposition of the lateral crura, as well as with convex shape of the lateral crura. No statistically significant association was found between the sagittal angle of the lateral crura and the type of nasal tip.

Level of Evidence V

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References

  1. Sepher A, Alexander AJ, Chauhan N, Chan H, Adamson PA (2010) Cephalic positioning of lateral crura: implications for nasal-tip plasty. Arch Facial Plast Surg 12(6):379–384

    Google Scholar 

  2. Constantian MB (2000) Four common anatomic variants that predispose to unfavorable rhinoplasty results: a study based on 150 consecutive secondary rhinoplasties. Plast Reconstr Aesthet Surg 105(1):316–331 (discussion 332–333)

    Article  CAS  Google Scholar 

  3. Sheen JH (1978) Aesthetic rhinoplasty. Mosby-Year Book Inc., St Louis

    Google Scholar 

  4. 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):261–267

    Article  Google Scholar 

  5. 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):268–281

    Article  CAS  Google Scholar 

  6. Kovacevic M, Friedman O, Riedel F, Wurm J, Bran G (2017) Management of the cephalically malpositioned lower lateral crus in aesthetic rhinoplasty. Facial Plast Surg 33:483–490

    Article  CAS  Google Scholar 

  7. Cakir B (2016) Aesthetic septorhinoplasty. Springer International Publishing, Cham, pp 66–79

    Book  Google Scholar 

  8. Hafezi F, Naghibzadeh B, Ashtiani AK (2018) Lower lateral cartilage cephalic malposition: an over-diagnosed entity. Aesth Plast Surg 42:867–876

    Article  Google Scholar 

  9. Cakır B, Dogan T, Oreroglu AR, Daniel RK (2013) Rhinoplasty: surface aesthetics and surgical techniques. Aesthet Surg J 33(3):363–375

    Article  Google Scholar 

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

    Article  Google Scholar 

  11. Daniel RK, Palhazi P, Gerbault O, Kosins AM (2014) Rhinoplasty: the lateral crura-alar ring. Aesthet Surg J 34(04):526–537

    Article  Google Scholar 

  12. Constantian MB (1993) Functional effects of alar cartilage malposition. Ann Plast Surg 30(6):943–952

    Article  Google Scholar 

  13. Toriumi DM, Asher SA (2015) Lateral crura repositioning for treatment of cephalic malposition. Facial Plast Surg Clin North Am 23(1):55–71

    Article  Google Scholar 

  14. Yeh CC, Williams EF III (2009) Cosmetic and functional effects of cephalic malposition of the lower lateral cartilages: a facial plastic surgical case study. Otolayngol Clin North Am 42(3):539–546

    Article  Google Scholar 

  15. Goksel A, Vladykina E (2017) Oblique turnover flap for repositioning and flattening of the lateral crura: a novel technique to manage cephalic malposition of lower lateral cartilage. Facial Plast Surg 33:491–498

    Article  CAS  Google Scholar 

  16. Toriumi D (2020) Nasal tip contour: anatomic bases for management. Facial Plast Surg Aesthet Med 22(1):10–24

    Article  Google Scholar 

  17. Toriumi D (2019) Structure rhinoplasty: lessons learned in thirty years. DMT Publishing, Chicago

    Google Scholar 

  18. Dosanjh AS, Hsu C, Gruber RP (2010) The hemitransdomal suture for narrowing the nasal tip. Ann Plast Surg 64:708–712

    Article  CAS  Google Scholar 

  19. Kovacevic M, Wurm J (2014) Cranial tip suture in nasal tip contouring. Facial Plast Surg 30:681–687

    Article  CAS  Google Scholar 

  20. Perkins SW, Sufyan AS (2011) The alar-spanning suture: a useful tool in rhinoplasty to refine the nasal tip. Arch Facial Plast Surg 13:421–424

    Article  Google Scholar 

  21. Daniel R, Palhazi P (2018) Rhinoplasty—an anatomical and clinical atlas. Springer International Publishing, Cham

    Google Scholar 

  22. Gruber RP, Nahai F, Bogdan MA, Friedman GD (2005) Changing the convexity and concavity of nasal cartilages and cartilage grafts with horizontal mattress sutures: part II. Clinical results. Plast Reconstr Surg 115:595–606

    Article  Google Scholar 

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

    Article  CAS  Google Scholar 

  24. Tellioglu AT, Cimen K (2007) Turn-in folding of the cephalic portion of the lateral crus to support the alar rim in rhinoplasty. Aesthet Plast Surg 31(3):306–310

    Article  Google Scholar 

  25. Gruber RP, Zhang AY, Mohebali K (2010) Preventing alar retraction by preservation of the lateral crus. Plast Reconstr Surg 126:581–588

    Article  CAS  Google Scholar 

  26. Davis RE (2015) Lateral crural tensioning for refinement of the wide and underprojected nasal tip: rethinking the lateral crural steal. Facial Plast Surg Clin North Am 23:23–53

    Article  Google Scholar 

  27. Boccieri A, Raimondi G (2008) The lateral crura stair-step technique: a modification of the Kridel lateral crura overlay technique. Arch Facial Plast Surg 10(1):56–64

    Article  Google Scholar 

  28. Oktem F, Tellioglu AT, Menevse GT (2010) Cartilage Z-plasty on lateral crus for treatment of alar cartilage malposition. J Plast Reconstr Aesthet Surg 63(5):801–808

    Article  Google Scholar 

  29. Boahene KD, Hilger PA (2009) Alar rim grafting in rhinoplasty: indications, technique and outcomes. Arch Facial Plast Surg 11(5):285–289

    Article  Google Scholar 

  30. Kemaloglu CA, Altiparmak M (2015) The alar rim flap: a novel technique to manage malpositioned lateral crura. Aesthet Surg J 35(8):920–926

    Article  Google Scholar 

  31. Mohebbi A, Azizi A, Tabatabaiee S (2015) Repositioned lateral crura flap technique for cephalic malposition in rhinoplasty. Plast Surg 23(3):183–188

    Article  CAS  Google Scholar 

  32. Constantian MB (2002) Indications and use of composite grafts in 100 consecutive secondary and tertiary rhinoplasty patients: introduction of the axial orientation. Plast Reconstr Surg 110(4):1116–1133

    PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Prof. António Gonçalves Ferreira, Chairman of the Instituto de Anatomia das Faculdade de Medicina da Universidade de Lisboa, for allowing this cadaver study in his Department. The authors would like to thank Dr. Hugo Amorim for his assistance on cadaver dissection. The authors would like to thank Dr. Fernando Vilhena de Mendonça for the medical illustrations of this manuscript.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Hospital Luz Arrabida, Praceta Henrique Moreira 150, 4400-346, VNGaia, Porto, Portugal

    Rui Xavier

  2. Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal

    Sofia Azeredo-Lopes

  3. University of Utrecht, Utrecht, The Netherlands

    Dirk-Jan Menger

  4. Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal

    Henrique Cyrne de Carvalho

  5. Faculdade de Medicina da Universidade do Porto, Centro Hospitalar e Universitário S. João and Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Porto, Portugal

    Jorge Spratley

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  1. Rui Xavier
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Correspondence to Rui Xavier.

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The authors declare that they have no conflicts of interest to disclose. The authors have no financial disclosures.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Xavier, R., Azeredo-Lopes, S., Menger, DJ. et al. Cephalic Malposition of the Lateral Crura and Parenthesis Deformity: A Cadaver Study in Caucasians. Aesth Plast Surg 44, 2244–2252 (2020). https://doi.org/10.1007/s00266-020-01845-5

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  • DOI: https://doi.org/10.1007/s00266-020-01845-5

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