The Lateral Crural Rein Falp: A Novel Technique for Management of Tip Rotation in Primary Rhinoplasty

THE LATERAL CRURAL REIN FALP: A NOVEL TECHNIQUE FOR MANAGEMENT OF TIP ROTATION IN PRIMARY RHINOPLASTY

ABSTRACT

Goals/Purpose: Different techniques have been proposed for control of tip rotation in rhinoplasty surgery. Maintenance of the applied tip rotation in the postoperative period is however of important significance. A loss of rotation after surgery not only results in a de-rotated tip, but can also create an unwanted supratip deformity.

The Lateral Crural Rein Flaps are introduced with the aim to use the cephalic portion of the lateral crura to create cartilage flaps used to control and stabilize tip rotation and be used in supplement for dorsal reconstruction. This procedure not only uses the cephalic portion of the lateral crura as a spreader graft adjunct, but also enables controlled management and proper stabilization of the lower lateral cartilages hence precise manipulation of tip rotation.

Methods/Technique: The technique was used in 11 primary open-approach rhinoplasty procedures with a mean follow-up of 12 months. The lateral crura excess cephalic portions were prepared as medial crura based cartilaginous flaps. The desired tip rotation was then simulated by applying traction to the Rein flap distal (cephalic) tails and the flaps were incorporated similar to spreader grafts to the nasal dorsum and stabilized achieving the anticipated tip rotation.

Results/Complications: The Lateral Crural Rein flap technique provided stability to the nasal tip while minimizing later de-rotation in the postoperative period. Long-term 1-year follow-ups revealed the maintenance of nasal tip rotation and symmetrical dorsal aesthetic lines.

Conclusion: The Lateral Crural Rein flap enables controlled manipulation of the nasal tip with an effective adjunct contribution to the nasal dorsum reconstruction. The cephalic resection of the lateral crura are not only preserved and used as supplemental spreader grafts but the flaps enable controlled management and long-term maintenance of tip rotation. The supplemental spreader graft effect of the technique in addition aids in opening of the internal valve area, especially in cases where used in combination with the upper lateral cartilages as autospreader flaps.

The Lateral Crural Rein flap is a powerful strategy for controlling nasal tip rotation while reducing the lateral crural cephalic excess. Longevity of the applied tip rotation is reinforced by secure attachment of the lower nasal cartilage complex with the mid-vault structures.