Comprehensive Review of Surgical Techniques for Correcting Cephalic Malposition of the Lower Lateral Cartilages in Rhinoplasty

Overview

Lateral crural malposition means the outer arms of the tip cartilages diverge less than 30 degrees from the midline, pointing toward the inner corner of the eye rather than outward. This creates both appearance and breathing problems. Many correction techniques have been described but never compared. The authors reviewed the literature, grouped the techniques, and analyzed what drives the choice between them.

Sections of note

• Article type: literature review categorizing and comparing techniques.
• Definition used: cartilages diverging less than 30 degrees from the midline toward the inner corner of the eye on the same side.
• Four technique groups: flaps, grafts, transection of the lateral crus, and suture based methods.
• Both functional and aesthetic outcomes were analyzed, along with factors driving technique selection.
• Stated determinants of choice: surgeon expertise, availability of cartilage, and patient specific anatomy.
• Stated finding: multiple techniques have shown favorable outcomes.
• Stated gap: long term data on complications and structural stability remain limited.
• The authors state this is the first comprehensive comparison of these techniques.

What it means for a patient

• Misangled tip cartilages produce a nose that both looks pinched or boxy and collapses on breathing in, so correction addresses two problems.
• Four different families of solution exist, ranging from moving the cartilage to supporting it with grafts to reshaping it with sutures.
• The choice depends partly on how much cartilage is available, which matters most in revision cases.
• The review reports no pooled rates or outcome figures, and explicitly identifies long term stability as unknown.

Why this paper matters

Cephalic malposition is a recognized cause of both a pinched tip and a collapsing side wall, and it is frequently missed before surgery. Organizing the scattered techniques into four groups makes them comparable for the first time. Which one to choose remains a matter of surgeon preference rather than evidence.

Terms

• Lateral crus: the outer arm of the lower nasal cartilage, forming the nostril rim and side wall.
• Cephalic malposition: the tip cartilages angled too far toward the eyes rather than outward.
• Medial canthus: the inner corner of the eye where the eyelids meet.
• Transection: cutting a structure across its width.
• Suture-based method: reshaping cartilage with stitches rather than cutting it.
• Structural stability: whether a correction holds its position over time.