Scroll Reconstruction: Fine Tuning of the Interface Between Middle and Lower Thirds in Rhinoplasty

Overview

The scroll area is where the upper and lower lateral cartilages meet, setting the relationship between the middle and lower thirds of the nose. This retrospective review of recorded intraoperative information examined how often the authors reconstructed it and what asymmetries were present.

Sections of note

• 364 consecutive primary open approach rhinoplasty cases performed by the first author between July 2011 and September 2015.
• 329 of 364 received some form of scroll reconstruction.
• Scroll reconstruction was performed in all deviated cases and in 88 percent of straight noses.
• The most common technique was overlapping repair, used in 88.3 percent.
• In the deviated nose group, alar rim asymmetry was present in 89.4 percent and alar crease asymmetry in 75 percent.
• In the straight nose group these were still frequent: alar rim asymmetry 14.2 percent, alar crease asymmetry 10.4 percent.
• The authors describe their approach as graduated, reproducible and individualized, aiming to prevent unintended component alterations. Level of evidence is not stated in the abstract.

What it means for a patient

• The junction between the middle and lower thirds of the nose was reconstructed in 9 of 10 patients here, so it is treated as routine rather than exceptional.
• Nostril rim and crease asymmetries were near universal in crooked noses and present in over 1 in 10 straight ones.
• Limits: single surgeon, retrospective, no comparison group, and the abstract reports intraoperative findings and technique frequency rather than outcomes.
• No postoperative results, satisfaction scores, or follow-up appear in the abstract.

Why this paper matters

The scroll area governs both the transition in the profile line and the internal valve angle, yet it is often disrupted incidentally during tip surgery. Documenting how often it needs reconstruction makes it a deliberate step. The paper reports practice patterns rather than whether reconstruction improves results.

Terms

• Scroll area: The junction where the upper and lower lateral cartilages overlap.
• Upper lateral cartilage: The paired cartilage forming the sidewall of the middle nose.
• Lower lateral cartilage: The paired cartilage forming the tip and nostril rim.
• Alar rim: The edge of the nostril.
• Alar crease: The groove where the nostril wall meets the cheek.