Patient Outcomes in Lateral Crural Repositioning and Reconstruction in Revision Rhinoplasty

Overview

The lateral crura are the outer arms of the lower nasal cartilages. Moving or rebuilding them is described as one of the more complex maneuvers in revision rhinoplasty. The authors reviewed patients who had this done for breathing reasons, appearance reasons or both, comparing questionnaire scores and a graded measure of side wall weakness before and after surgery.

Sections of note

• Design: retrospective case series, 42 patients identified.
• Two follow up windows: PO1 at 6 months or less, mean 3.1 months; PO2 beyond 6 months, mean 11.5 months.
• Measures: SCHNOS obstruction and cosmesis subscales, functional and cosmetic visual analog scales, and lateral wall insufficiency grades.
• All four patient reported measures improved significantly at both follow up windows, p less than 0.05.
• Lateral wall insufficiency changes were significant on both sides at zone 1 at both time points.
• At zone 2, the change reached significance only on the left side and only at the later time point.
• Stated conclusion: the maneuver is effective in a subset of patients, improving tip appearance while preserving function.

What it means for a patient

• Repositioning the tip cartilages addresses appearance and breathing at once, and both improved here.
• The improvement in side wall support was uneven. Zone 1, nearer the nostril, improved reliably; zone 2 mostly did not.
• The authors themselves limit the claim to a subset of patients, without stating in the abstract who that subset is.
• Limits: 42 patients, retrospective, no comparison group, one center, and follow up averaging under a year in the later window.

Why this paper matters

Malpositioned lateral crura are a common finding in noses that look pinched and breathe poorly after a first operation, and correcting them requires taking the tip apart. Documenting that patients report improvement supports the effort involved. Which patients benefit most, and how long the correction lasts, remains open.

Terms

• Lateral crus: the outer arm of the lower nasal cartilage, forming the nostril rim and side wall.
• Revision rhinoplasty: a second operation to correct the result of an earlier one.
• SCHNOS: a validated questionnaire scoring both nasal appearance and nasal blockage.
• Visual analog scale: a line on which a patient marks the severity of a symptom.
• Lateral wall insufficiency: graded weakness of the side of the nose that lets it collapse on breathing in.