Scroll Ligament Repair in Dorsal Preservation Rhinoplasty: A Cartilage as a Guide on Nasal Skin Envelope for Suturing

Tuluy Y, Çelik V, Parspancı A, Sır E.

PubMed 39966153 Publisher (DOI)Free full text (PMC)

What this paper says

In 216 closed preservation rhinoplasties, a small strip of cartilage was deliberately left attached to the skin as a landmark for repairing the scroll ligament, with 196 of 203 rating breathing good or very good.

Overview

The scroll ligament connects the upper and lower nasal cartilages and supports both breathing valves, and repairing it is reported to give good functional and aesthetic results. The difficulty is finding the correct anatomical position for the repair at the end of surgery. The authors left a marker of cartilage on the skin to guide it.

Sections of note

Design: retrospective review of 216 patients having closed preservation rhinoplasty with modified low septal strip septoplasty. Level of evidence IV.
Technique: a 10 by 1 millimetre strip of cartilage is left attached to the skin envelope at the midpoint of the upper part of the lateral crus, marking where the ligament belongs.
Complications: residual humps in 2 patients, inferior turbinate enlargement in 4, total septal reconstruction in 1.
203 patients rated their results. Breathing: 116 very good, 80 good, 4 moderate, 3 poor. Appearance: 128 very good, 72 good, 3 moderate.
Stated benefits: support for both breathing valves, better skin redraping and elimination of dead space.

What it means for a patient

Cutting the scroll ligament during surgery removes support from the breathing valves, and reattaching it in the right place is the point of this marker.
Reported outcomes were good, with about 96 percent rating breathing good or very good.
Residual hump occurred in only 2 of 216 patients, low for a preservation series.
Limits: retrospective, no comparison group without the marker technique, no stated follow up period, and ratings on an unvalidated four point scale, with 203 of 216 patients responding.

Why this paper matters

Ligament preservation and repair has become a live question in rhinoplasty, and one obstacle is that once the tissue is lifted, the original position is hard to identify. A physical landmark left in place is a practical answer. Whether repairing the ligament improves measured breathing over not repairing it is untested here.

Terms

Scroll ligament: the fibrous connection between the upper and lower nasal cartilages.
Internal and external nasal valves: the two narrow points of the nasal airway that can collapse.
Lateral crus: the outer arm of the lower nasal cartilage, forming the nostril rim and side wall.
Nasal skin envelope: the skin and underlying layers covering the nasal framework.
Dead space: an empty pocket under lifted tissue where fluid can collect.

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

Abstract

Background: The scroll ligament provides support to the internal and external valve, and its repair in rhinoplasty provides good functional and aesthetic results. In this study, it was aimed to repair the scroll ligament complex by leaving cartilage in the nasal skin envelope, and clinical results were shared.

Patients And Methods: 216 patients who underwent closed preservation rhinoplasty with modified low septal strip septoplasty were included in the study. A 10 x 1 mm of cartilage is left in the nasal skin envelope at the midpoint of the cranial part of the lateral crus of the LLC, leaving it as a guide to repair the scroll ligament complex in the anatomically correct place. Demographic data, complications, revision surgeries, follow-up periods and satisfaction of the patients were analyzed retrospectively.

Results: Residual humps were observed in 2 patients. Inferior turbinate hypertrophy was observed in 4 patients. In 1 patient, total septal reconstruction was performed. Two hundred and three patients were evaluated the results as poor, moderate, good and very good. One hundred and sixteen patients rated the functional outcome as very good, 80 patients as good, 4 patients as moderate and 3 patients as poor. One hundred and twenty-eight patients rated the aesthetic result as very good, 72 as good and 3 as moderate.

Conclusion: Repairing the scroll ligament complex provides both internal and external valve support, better redraping and eliminating the dead space. Leaving cartilage on the nasal skin envelope as a guide helps to repair the scroll ligament complex in the anatomically correct place at the end of the surgery.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).