Lateral crural turn-in flap in functional rhinoplasty

Apaydin F.

PubMed 22006234 Publisher (DOI)

What this paper says

In 24 patients whose tip cartilages were wider than 12 mm, the strip normally trimmed from the top edge was folded under the remaining cartilage to support both nasal valves, and in one patient with concave cartilage it widened the internal valve angle.

Overview

Slimming a bulbous tip usually means cutting away the upper edge of each lateral crus and discarding it, which can weaken the side wall and valves. The author instead keeps the trimmed strip attached, turns it into a pocket under the remaining crus, and uses it as a built-in support, preserving the scroll junction with the upper lateral cartilage.

Sections of note

24 patients with lateral crura wider than 12 mm.
Technique: cephalic trim of the lateral crus, then the trimmed strip is turned into a pocket under the remaining crus, forming a cartilage "sandwich."
The scroll area is kept intact, supporting the internal valve.
The support and suspension prevented narrowing of the internal valve angle and widened it in some cases.
Reported as used with great success; the abstract gives no outcome scores, follow-up length or complication counts.
The author recommends combining it with spreader flaps or grafts, or alar batten grafts, for maximum functional result.

What it means for a patient

Tip narrowing can be done in a way that recycles the removed cartilage as support instead of throwing it away.
The method is aimed at keeping or improving breathing while refining the tip.
One surgeon's series with no measured breathing outcomes or comparison group in the abstract.

Why this paper matters

The turn-in flap is part of a shift from excising tip cartilage to preserving and repositioning it, and it became a widely adopted maneuver. Objective airflow data and long-term shape stability are not reported here.

Terms

Lateral crus: the side arm of the tip cartilage running along the nostril.
Cephalic trim: removing the upper edge of the lateral crus to refine the tip.
Internal nasal valve: the narrowest part of the airway, between the septum and the upper lateral cartilage.
External nasal valve: the nostril opening, supported by the lateral crus.
Scroll area: the junction where the tip cartilages overlap the upper lateral cartilages.
Alar batten graft: a cartilage strip placed along a weak side wall to stop it collapsing on inspiration.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“To use the trimmed cartilage as a support material for both internal and external valves. Methods: The lateral crural turn-in flap (LCTF) technique is simply to make cephalic trimming of the lateral crura and turn it into a pocket created under the remaining lateral crus. Twenty-four patients with lateral crura wider…”

Excerpt; the full abstract is on PubMed.