The Deviated Nasal Tip: A Personal Technique for Correction Using Monolateral Crural Overlay and Monolateral Dome Truncation

Abstract

This study aimed to present a novel approach to correct nasal tip deviation with monolateral crural overlay or monolateral dome truncation, presenting as an isolated deformity or in complex nose deviations. Nasal tip deviation can be congenital or posttraumatic, due to a dislocated septum or cartilaginous septal or lower lateral cartilage malformations. Although some treatment strategies have been introduced, appropriate treatment remains a challenge because of the complexity and variability of such deformities. It had been assumed that in most nasal tip deviations, a lower lateral cartilage was longer than the contralateral one. The authors analyzed 158 patients from January 2015 to October 2019 with nasal tip deviation and corrected the deviated tip by using a monolateral interruptive technique (lateral crural overlay or monolateral dome truncation) on the lower lateral cartilage. Photographic comparison between preoperative and at least 1-year follow-up for nasal axis deviation variable was analyzed and a self-assessment questionnaire was administrated to the patients at 1-year follow-up. The mean nasal deviation was 6.59° (±3.1°) preoperatively and 1.56° (±0.26°) postoperatively (p < 0.05). The range of differences between pre and postoperative deviations was 2.7° to 15.1°, and the mean difference was 6.1° (±3.21°). Of the 84 patients, 47 (55.95%) were very satisfied, 33 (39.28%) were satisfied, and 4 (4.76%) were unsatisfied with surgical the results and required revision surgery. In authors' hands, monolateral interruptive techniques (lateral crural overlay or monolateral dome truncation) are a viable and feasible option to restore nasal tip symmetry. These techniques achieved high satisfaction rates among patients and resulted in reliable and reproducible symmetry immediately visible after surgery and stable over time (1-year postsurgery controls).

Keywords

rhinoplasty - monolateral dome truncation - monolateral crural overlay

Publication History

Article published online:
01 February 2021

• References

• 1 Manafi A, Rajaee A, Manafi A. Concomitant overlap steal tip-plasty: a versatile technique to simultaneously adjust the rotation, definition, projection, and symmetry of the nasal tip. Aesthet Surg J 2016; 36 (02) 147-155
• 2 Gunter JP, Rohrich RJ. Management of the deviated nose. The importance of septal reconstruction. Clin Plast Surg 1988; 15 (01) 43-55
• 3 Byrd HS, Salomon J, Flood J. Correction of the crooked nose. Plast Reconstr Surg 1998; 102 (06) 2148-2157
• 4 Rohrich RJ, Griffin JR. Correction of intrinsic nasal tip asymmetries in primary rhinoplasty. Plast Reconstr Surg 2003; 112 (06) 1699-1712 , discussion 713–715
• 5 Boccieri A. The crooked nose. Acta Otorhinolaryngol Ital 2013; 33 (03) 163-168
• 6 Inanli S, Binnetoglu A. A combined approach to crooked nose deformity. Aesthetic Plast Surg 2016; 40 (03) 360-366
• 7 Pascali M, Boccieri A, Carinci F, Cervelli V. Treatment of the crooked nose: the final steps to perfection. J Craniofac Surg 2017; 28 (02) 372-378
• 8 Pedroza F. A 20-year review of the “new domes” technique for refining the drooping nasal tip. Arch Facial Plast Surg 2002; 4 (03) 157-163
• 9 Patrocínio LG, Patrocínio TG, Barreto DM, Subhan YS, Patrocínio JA. Evaluation of lateral crural steal in nasal tip surgery. JAMA Facial Plast Surg 2014; 16 (06) 400-404
• 10 Foda HMT, Kridel RWH. Lateral crural steal and lateral crural overlay: an objective evaluation. Arch Otolaryngol Head Neck Surg 1999; 125 (12) 1365-1370
• 11 Kridel RW, Scott BA, Foda HM. The tongue-in-groove technique in septorhinoplasty. A 10-year experience. Arch Facial Plast Surg 1999; 1 (04) 246-256 , discussion 257–258
• 12 Bohluli B, Bagheri SC, Behkish B, Moharamnejad N, Sadr-Eshkevari P, Rashad A. Immediate effects of different steps of rhinoplasty on nasolabial angle and tip projection. J Craniofac Surg 2014; 25 (05) e404-e406
• 13 Daniel RK. Tip refinement grafts: the designer tip. Aesthet Surg J 2009; 29 (06) 528-537
• 14 Rhea JT, Rao PM, Novelline RA. Helical CT and three-dimensional CT of facial and orbital injury. Radiol Clin North Am 1999; 37 (03) 489-513
• 15 Graviero G, Guastini L, Mora R, Salzano G, Salzano FA. The role of three-dimensional CT in the evaluation of nasal structures and anomalies. Eur Arch Otorhinolaryngol 2011; 268 (08) 1163-1167
• 16 Boccieri A, Sciuto S, Cervelli V. Dome division : a viable technique today?. Facial Plast Surg 2016; 664-670
• 17 Anderson JR. A reasoned approach to nasal base surgery. Arch Otolaryngol 1984; 110 (06) 349-358
• 18 Kridel RWH, Konior RJ. Controlled nasal tip rotation via the lateral crural overlay technique. Arch Otolaryngol Head Neck Surg 1991; 117 (04) 411-415
• 19 Goldman IB. The importance of the mesial crura in nasal-tip reconstruction. AMA Arch Otolaryngol 1957; 65 (02) 143-147