External valve deformity: correction by composite flap elevation and mattress sutures
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Updated: Jun 2, 2026
Coronoid-Temporalis Pedicled Flap for Orbital Floor Defect Reconstruction
Published on: December 5, 2025
Ronald P Gruber1, Edward T Melkun, J Bradley Strawn
1Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94304, USA. rgrubermd@hotmail.com
Background:
Deformities of the external valve (lateral crus) are an occasional problem following rhinoplasty. One of the most notable problems is when the posterior aspect of the lateral crus curls around into the vestibule. It not only obstructs the airway but can be aesthetically displeasing to the patient. Traditional correction including grafts works can be complicated and often leaves the lateral wall bulky.
Methods:
A U-shaped incision is made around the lateral crus creating a medially based composite flap. This flap contains most of the lateral crus and is delivered into the vestibule for the application of one or more horizontal mattress sutures to the convex surface of the cartilage. These sutures act to straighten out the lateral crus prior to replacing it in its bed.
Results:
Seven patients with a deformity of the posterior aspect of the lateral crus received correction by composite flap elevation and mattress suture application. Follow-up ranged from 10 to 33 months. All but one patient had their aesthetic and functional symptoms corrected; this required a symmetry procedure secondary to the loss of alar groove depth.
Conclusion:
Exposure of the entire lateral curs with the use of a medially based composite flap containing most of the lateral crus is an excellent means to control its shape. Mattress sutures applied to the surface of the cartilage will result in increased stiffness and strength. The net result is a simple correction of what might otherwise be a complicated problem.
