Rhinoplasty: the lateral crura-alar ring

Overview

Surgeons routinely cut or remove part of the lateral crura, and rim retraction, bossae and collapse can follow. Given renewed interest in preserving these cartilages, the authors set out to measure them. The work had two parts: intraoperative measurement in living patients and dissection of fresh cadavers to reach areas that cannot be seen during surgery.

Sections of note

• Prospective measurement of 40 consecutive rhinoplasty patients, all women, plus 20 fresh cadaver dissections.
• Average patient age was 28 years, range 14 to 51; average cadaver age was 74 years, range 57 to 88.
• In patients, distance of the lateral crura from the mid nostril point averaged 5.9 mm and cephalic orientation averaged 43.6 degrees.
• Maximal lateral crural width in patients averaged 10.1 mm; the most common shape was smooth and straight horizontally with the cephalic border higher than the caudal border.
• In cadavers the lateral crura averaged 23.4 mm long, 6.4 mm wide at the domal notch, 11.1 mm wide at the turning point and 0.5 mm thick.
• The accessory cartilage chain and the alar ring were found in every dissection, running around toward the anterior nasal spine without touching the pyriform aperture.

What it means for a patient

• The nostril rim is supported by a continuous cartilage ring, which is part of why removing cartilage can cause the rim to notch or collapse.
• The numbers give surgeons normal ranges to aim for when reshaping rather than removing tissue.
• This is anatomy, not outcomes. No surgical results, complication rates or follow-up are reported.
• The patient group was all female and the cadavers were mostly older men, so the two sets are not directly comparable.

Why this paper matters

It supplies measured anatomy behind the shift toward preserving rather than excising tip cartilage. It does not test whether preservation lowers deformity rates in practice.

Terms

• Lateral crus: the outer arm of the lower tip cartilage that supports the nostril rim.
• Alar ring: the continuous loop of cartilage running around the nostril.
• Domal notch: the bend at the tip where the cartilage turns from inner to outer arm.
• Alar malposition: tip cartilage lying in an abnormal position or angle.
• Pyriform aperture: the pear shaped bony opening of the nose in the skull.