The sandwiched lateral crural reinforcement graft: a novel technique for lateral crus reinforcement in rhinoplasty

Kuran I, Oreroğlu AR.

What this paper says

In 30 primary open rhinoplasty patients, a graft that sandwiches a cartilage strut between two layers of the patient's own tip cartilage produced no graft displacement or tip deformity over a mean 24 months.

Overview

Weak or misshapen lateral crura let the side of the nostril cave inward on deep breathing. The standard lateral crural strut graft can slip out of position afterward and create a visible deformity. The authors describe a variant, the sandwiched lateral crural reinforcement graft, and report their own series.

Sections of note

Thirty non-consecutive primary open rhinoplasty operations by one senior surgeon between February 2010 and May 2012.
Patients were 5 men and 25 women, aged 22 to 45 years, median 35 years.
Technique: cephalic excess of the lateral crus is cut and placed under the crus, the strut graft is set between the two cartilage layers, and the cephalic edges of both segments are sutured together.
Indications were external valve collapse in 50 percent, support after correcting cephalic malposition in 30 percent, and reinforcement after deformity from dome-shaping sutures in 20 percent.
No graft displacement or tip disfigurement was seen, at a mean follow-up of 24 months.
The paper is graded level of evidence 4.

What it means for a patient

This method reuses cartilage that is often discarded, so less tissue needs to be taken from elsewhere.
The reported benefit is a graft that stays where it was placed over about two years.
There was no comparison group, cases were not consecutive, and all surgery was by a single surgeon, so results may not transfer.
No breathing measurements or patient rated outcomes are given in the abstract.

Why this paper matters

Nostril sidewall collapse is a common reason for revision, and graft stability is the weak point of existing solutions. It remains unknown whether this variant outperforms the standard strut graft in a direct comparison.

Terms

Lateral crus: the outer arm of the lower tip cartilage that supports the nostril rim.
Cephalic: toward the top or head end of a structure.
External nasal valve: the nostril opening, which can collapse inward on breathing in.
Cephalic malposition: tip cartilage sitting higher and more sideways than normal.
Dome-shaping sutures: stitches that narrow and define the point of the tip.

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

From the abstract

“Misshapen or weak lateral crura can cause an inward collapse of the lateral crus observed on deep inspiration. The lateral crural strut graft is a popular technique for reinforcing lateral crura. Failure to stabilize the graft properly can, however, result in graft displacement postoperatively and an accompanying…”

Excerpt; the full abstract is on PubMed.