+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

A problem-oriented and segmental open approach to alar cartilage losses and alar length discrepancies

A problem-oriented and segmental open approach to alar cartilage losses and alar length discrepancies

Plastic and Reconstructive Surgery 109(2): 768

Alar cartilage losses and alar length discrepancies present problems in nasal tip support, contour, and symmetry. The true extent of the cartilage defect is often not apparent until the time of surgery. This article examines a problem-oriented and segmental open approach to such deformities. It is based on the size of the defect, its location within the dome and lateral crus, and the presence or absence of alar collapse. The defects are classified as major when there is a total or near total loss of the lateral crus, moderate when more than 5 mm is involved, and minor when less than 5 mm is affected. In major defects, a segmental reconstruction of the nasal tip cartilages is undertaken. It consists of a septal graft for columellar support and a conchal shield graft and umbrella graft for nasal tip contour. The whole length of the lateral crus is not reconstructed unless alar collapse is present. In moderate cartilage defects, usually seen laterally in secondary rhinoplasties, the remaining central dome segments are remodeled with shaping sutures. Moderate cartilage length discrepancies, as seen in unilateral cleft lip noses, are equalized through reversed alar rotations. The short crus is rotated laterally, taking length from the medial crus, and the long crus is rotated medially, with the excess advanced into the medial crural footplate. Additional shortening of the long crus can be achieved through cartilage division and advancement. The balanced alar units are then raised with tip projection-vector sutures, and onlay grafts are added if required. In minor cartilage losses, symmetry is usually obtained by shortening the opposite uninjured crus. A total of 33 patients are examined in this review. The average follow-up is 14 months. An improvement in nasal tip shape and support was achieved in all patients.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 045097228

Download citation: RISBibTeXText

PMID: 11818869

DOI: 10.1097/00006534-200202000-00056

Related references

A Problem-Oriented and Segmental Open Approach to Alar Cartilage Losses and Alar Length Discrepancies by Bernd R. Neu, M.D. Plastic and Reconstructive Surgery 109(2): 780-782, 2002

"Alar leapfrog". A technique for repositioning the total alar cartilage at primary cleft lip repair. Clinics in Plastic Surgery 12(4): 643-658, 1985

Cleft lip nasal deformity corrected by an alar flap and the alar cartilage sling method. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. Acta Academiae Medicinae Sinicae 25(5): 619-621, 2003

Bilateral alar cartilage reduction rhinoplasty allows primary repair of alar defects in the bulbous nose. Journal of Cutaneous Medicine and Surgery 16(6): 424-427, 2012

Novel technique and simple approach for supra-alar region and supra-alar crease correction by supra-alar cinching. National Journal of Maxillofacial Surgery 7(1): 108-110, 2016

Optimizing the Soft Tissue Triangle, Alar Margin Furrow, and Alar Ridge Aesthetics: Analysis and Use of the Articulate Alar Rim Graft. Facial Plastic Surgery 32(6): 646-655, 2016

Elliptical horizontal excision and repair of alar cartilage in open-approach rhinoplasty to correct cartilaginous tip deformities. Plastic and Reconstructive Surgery 101(1): 177, 1998

Assessment of Alar Flare and Efficacy of Alar Cinch Suture in the Management of Alar Flare Following Le Fort 1 Superior Repositioning: A Comparative Study. Journal of Maxillofacial and Oral Surgery 15(4): 528-534, 2016

Crushed Cartilage Grafts over Alar Dome Reduction in Open Rhinoplasty. Plastic and Reconstructive Surgery 105(2): 792-795, 2000

Crushed cartilage grafts over alar dome reduction in open rhinoplasty. Plastic and Reconstructive Surgery 92(2): 352-356, 1993

Primary rhinocheiloplasty: Comparison of open and closed methods of alar cartilage reposition. Annals of Maxillofacial Surgery 6(1): 21-24, 2016

Alar Rim Reconstruction With Autologous Graft Cartilage: External Approach. Journal of Craniofacial Surgery 30(3): 868-870, 2019

A new approach in open rhinoplasty: new alar rim raising technique. Journal of Otolaryngology - Head and Neck Surgery 40(1): 54-57, 2011

Treatment of external nasal valve (alar rim) collapse with an alar strut. Journal of Laryngology and Otology 115(10): 788-791, 2001

Alar rotation flap for full thickness medial alar defects. Journal of Plastic Reconstructive and Aesthetic Surgery 67(6): 866-868, 2014