Modification of the Lateral Crural Suspension Flap — Suleyman Tas PubMed

MODIFICATION OF THE LATERAL CRURAL SUSPENSION FLAP To the Editor:— I have recently modified the lateral crural suspension flap (LCSF), as described by Bohluli et al, 1 when used to stabilize the nasolabial angle and suspend the nasal tip. In the original description, 2 flaps are prepared on the lateral crural cartilages that start medially at the begin- ning of the dome, with a 3-mm width, and extend laterally as cephalic trim. Next, these 2 flaps are sutured to the septum and aligned with the lateral surfaces. The lower lateral cartilage has been described as a tripod 2 divided into 3 segments: medial, intermediate, and lateral crura. The intermediate crura will overlap the caudal edge of the septum and constitute the domes and rest within the nasal tip. 3 Modification of the length of the tripod’s legs and support can affect the nasal shape, structure, appearance and function. 2,4 Letters to the Editor must be in reference to a specific article or editorial that has been published by the Journal. Letters must be submitted within 6 weeks of the article’s print publication or, for an online-only article, within 8 weeks of the date it first appeared online. Letters must be submitted electronically via the Elsevier Editorial System at http://ees.elsevier.com/ joms. Letters are subject to editing and those exceeding 500 words may be shortened or not accepted due to length. One photograph may accompany the letter if it is essential to understanding the subject. Letters should not duplicate similar material or material published elsewhere. There is no guarantee that any letter will be published. Prepublication proofs will not be provided. Submitting a Letter to the Editor constitutes the author’s permission for its publication in any issue or edition of the journal, in any form or medium. 846

The tip projection and rotation are best evaluated from the lateral view. The nasal tip is perhaps the most defining feature of a nose. 3 On the lateral view, the relationship be- tween the nasal tip and dorsum should be discussed with the patient before the operation. Generally , for female pa- tients, a supratip break will be requested; however, for men, the nasal tip and dorsum might be preferred to be at the same level. 5 However, because the pivot point of these flaps is the apex of the alar cartilage, it will be at the same level as the nasal dorsum. Thus, a desirable supratip break will not be possible, and an amount of tip projection will be lost because these flaps will pull posterior and downward. This problem is very important, especially for female pa- tients. Thus, rather than incise and dissect the flap medi- ally up to the domes, the pivot points of the flaps should be planned 4 to 5 mm more cephalically ( Fig 1 ). Thus, when the flap is sutured to the septum, a supratip break point can be achieved, with a desirable nasolabial angle. In addition, this modification serves as a lateral crural su- ture for correcting boxy nose deformities. Second, rather than suturing the lateral sides of the flaps to the septum, the medial sides of the flaps should be sutured. Thus, a stronger coaptation can be gained, and a possible shape deformity will be avoided owing to the curvature of the flaps. I consider that in selected patients, modified LCSF can remedy 4 issues at one time (‘ ‘hit 4 birds with 1 stone’ ’), such as serving as a spreader graft, a lateral crural suture, and providing a supratip break and a good nasola- bial angle. S€ ULEYMAN TA S¸, MD, P HD Rize, Turkey References 1. Bohluli B, Varedi P , Nazari S, Bagheri SC: Lateral crural suspension flap: A novel technique to modify and stabilize the nasolabial angle. J Oral Maxillofac Surg 71:1572, 2013 2. Powell N, Humphreys B: Proportions of the Aesthetic Face. New Y ork, Thieme-Stratton, 1984, pp 128–132 3. Taub PJ, Baker SB: Rhinoplasty: McGraw-Hill Plastic Surgery Atlas. New Y ork, McGraw-Hill, 2012, pp 6, 16 4. Crumley RL, Lanser M: Quantitative analysis of the nasal tip pro- jection. Laryngoscope 98:202, 1988 5. Tebbetts JB: Primary Rhinoplasty: Redefining the Logic and Techniques. Philadelphia, Elsevier Mosby , 2008, pp 133-134. http://dx.doi.org/10.1016/j.joms.2013.10.027 print & web 4C =FPO FIGURE 1. View after completing the elevation of modified lateral crural suspension flap (LCSFs). The yellow arrow shows the distance bet- ween dome and pivot point of the modified LCSF . S€uleyman Tas¸. Letters to the editor . J Oral Maxillofac Surg 2014. LETTERS TO THE EDITOR 847