Management of Lateral Crura Deformity in Functional and Aesthetic Rhinoplasty: Classification, Surgical Algorithm, and Outcome-Based Approach

Overview

The lateral crura are the side arms of the tip cartilages; when weak, curled or mispositioned they cause a poor tip shape, nostril collapse and blocked breathing. The Indian authors describe a classification system and a structured surgical algorithm, applied in a mixed retrospective-prospective study of patients having primary or revision rhinoplasty with lateral crural work between 2022 and 2025. Outcomes: photographic analysis, a 5-point satisfaction scale, and NOSE.

Sections of note

• 50 patients: 80% primary, 20% revision.
• Mean follow-up 14.2 months (range 6-24).
• Mean NOSE score improved (values not given in the abstract).
• 90% reported significant aesthetic and functional improvement.
• Two patients (4%) had revision for minor asymmetry.
• The authors' principle: prioritise "preservation and restoration over excessive excision."

What it means for a patient

• Problems with the nostril-side cartilage are treated by repositioning and reinforcing rather than cutting away, which in this series protected breathing.
• Nine in ten patients reported improvement in both appearance and breathing.
• The numbers are small and outcome figures are incompletely reported.

Why this paper matters

It offers a structured decision tool for a common tip problem, consistent with the trend away from cartilage excision. Limits: 50 patients, no comparison group, NOSE change not quantified in the abstract.

Terms

• Lateral crura: the outer legs of the lower lateral cartilages, running along the nostril rims.
• Alar insufficiency: weakness of the nostril wall leading to collapse on inhalation.
• External nasal valve: the nostril opening, supported by the lateral crura.
• Cephalic malposition: lateral crura angled too far upward, giving a bulbous tip and weak rims.
• NOSE: a validated 0-100 nasal obstruction score.