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An Objective Evaluation

Hossam M. T. Foda, MD; Russell W. H. Kridel, MD

Arch Otolaryngol Head Neck Surg. 1999;125:1365-1370.

Objective  To assess objectively the effect of 2 cartilage-modifying techniques, lateral crural steal (LCS) and lateral crural overlay (LCO), on the degree of nasal tip projection and rotation.

Design  A prospective trial using computer imaging techniques for assessment.

Settings  Half of the patients were seen at a university hospital and the other half at a private practice.

Patients  A selected series of 30 patients seeking rhinoplasty mainly for nasal tip repositioning. Only patients with no history of previous nasal operations were included.

Intervention  All patients were operated on using an external rhinoplasty approach. Only 1 of the 2 techniques was adopted for each patient. The technique selected depended purely on clinical judgment.

Main Outcome Measures  The nasofacial angle and the Goode ratio were used to assess tip projection, and the nasolabial angle and rotation angle were used to assess tip rotation.

Results  The use of the LCS technique resulted in an increase in both nasal tip projection and rotation, but the use of the LCO technique resulted in an increase in tip rotation and a decrease in tip projection (P<.001). Additionally, the LCO technique resulted in significantly higher degrees of rotation than the LCS technique (P<.001).

Conclusions  The LCS procedure is indicated when a moderate increase in nasal tip projection and rotation is desired. The LCO technique is useful in patients where severe underrotation is associated with overprojection.

From the Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Alexandria Medical School, Alexandria, Egypt (Dr Foda); the Department of Otolaryngology and Communicative Sciences, Baylor College of Medicine, and the Department of Otolaryngology–Head and Neck Surgery, University of Texas Health Science Center at Houston (Dr Kridel). Dr Kridel is also in private practice in Houston.

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