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Intermediate Crural Overlay in Rhinoplasty
A Deprojection Technique That Shortens the Medial Leg of the Tripod Without Lengthening the Nose
Jeffrey B. Wise, MD;
Samuel S. Becker, MD, MFA;
Anthony Sparano, MD;
Jacob Steiger, MD;
Daniel G. Becker, MD
Arch Facial Plast Surg. 2006;8:240-244.
Objective To review the indications for, surgical techniques of, and results of intermediate crural overlay of the alar cartilages in rhinoplasty.
Design Prospective study of patients undergoing intermediate crural overlay of the lower lateral cartilages. The setting was a facial plastic surgery private practice. Patients included 10 primary rhinoplasty patients and 1 revision rhinoplasty patient who underwent intermediate crural overlay of the lower lateral cartilages. The main outcome measures were postoperative photographs and patient records, which were reviewed for tip projection and rotation, preservation of the double break, bossae, and knuckling.
Results Intermediate crural overlay decreased projection in all 11 patients and increased the nasolabial angle in 7 patients. One patient had no change in the nasolabial angle, and 3 patients had counterrotation of 1°, 3°, and 4°. A postoperative physical examination revealed that no patient had developed bossae, tip asymmetries, or knuckling. In addition, the double break was maintained in all the study patients.
Conclusions Intermedial crural overlay is a reliable technique for achieving tip deprojection. Overall, the nasolabial angle is maintained (although in 3 patients, clinically insignificant counterrotation did occur). In addition, the length of the intermediate crura is reduced, but the double break is preserved. In the group of patients with thin skin and tip overprojection secondary to overdevelopment of the lower lateral cartilages, intermediate crural overlay achieves tip deprojection while controlling the nasolabial angle and preserving the natural curvature of the dome.
Author Affiliations: Division of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania Medical Center, Philadelphia (Drs Wise, Sparano, Steiger, and D. G. Becker); and Department of Otolaryngology–Head and Neck Surgery, University of Virginia Medical Center, Charlottesville (Dr S. S. Becker). Dr D. G. Becker is also in private practice in Sewell, NJ.
RELATED LETTER
The Nasal Tripod Revisited
George L. Murrell
Arch Facial Plast Surg. 2007;9(2):141-142.
EXTRACT
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THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
The Nasal Tripod Revisited
Murrell
Arch Facial Plast Surg 2007;9:141-142.
FULL TEXT
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