Assessment of nasal function after tip surgery with a cephalic hinged flap of the lateral crura: A randomized clinical trial

Abstract

Background: Postrhinoplasty nasal obstruction has been ascribed to either postreductive narrowing of the midvault or dynamic collapse resulting from lateral wall insufficiency. Recently, clinicians have reported on various surgical techniques that maximally preserve alar cartilage integrity, unlike the earlier popular methods of tip reduction surgery. Objectives: The authors compared the effects of 2 rhinoplasty techniques: a cephalic trim (CT) of the lateral crura (LC) and a horizontal resection with cephalic hinged flap (HRCH) of the LC of the lower lateral cartilage (LLC). Methods: Fifty-two patients who presented with a bulbous nasal tip deformity were randomly assigned to 1 of 2 groups and underwent either CT of the LC or HRCH. Effects of the procedures were evaluated by both acoustic rhinometry (AR; first and second minimal cross-sectional areas [MCA1 and MCA2, respectively]) and by subjective scoring on a global nasal obstruction visual analog scale (VAS). Assessments were made before and after rhinoplasty. Results: MCA1 and MCA2 were increased after both CT and HRCH. This increase was significant on the right side for both CT ( P < .001) and HRCH ( P = .001), but the increase on the left side was significant only for HRCH. Conclusions: The improvement noted in breathing quality by VAS and AR suggests that a hinged flap may be effective in reconstructing the internal nasal valve. © 2014 The American Society for Aesthetic Plastic Surgery, Inc.