Lower Lateral Cartilage Cephalic Malposition: An Over-Diagnosed Entity

Area of Science:

• Plastic Surgery
• Facial Anatomy
• Rhinoplasty Techniques

Background:

• Lower lateral cartilage (LLC) malposition, characterized by anterior dome convexity and posterior pinch, is a common finding in rhinoplasty.
• This variation, often termed
• bulbous pinch,
• involves cephalic (upward and inward) rotation of lateral crura, particularly in patients with bulbous nasal tips.
• Traditionally, cephalic displacement of the LLC is cited as the primary cause, leading to recommendations for caudal repositioning.

Purpose of the Study:

• To precisely measure the angles of the lateral crura relative to fixed facial reference points.
• To investigate the anatomical basis of nasal lateral wall pinching in rhinoplasty patients.

Main Methods:

• Analyzed 40 consecutive rhinoplasty cases, marking lower lateral cartilage (LLC) contours and reference lines.
• Categorized cases into "bulbous pinch" and "flat LLC" groups.
• Measured and compared the angles of the right and left lateral crura to the midline and horizontal planes between groups.

Main Results:

• No statistically significant difference was found in the angles of lower lateral cartilage (LLC) rotation between the "bulbous pinch" and "flat LLC" groups.
• Measurements included both vertical and horizontal angles of the lateral crura.

Conclusions:

• Cephalic malposition of the lower lateral cartilage (LLC) is an uncommon variation, despite its reported high frequency.
• Severe convexity of the posterior and lateral crura, rather than cephalic displacement, is the likely etiology for nasal lateral wall pinching in most cases.
• Findings suggest a need to re-evaluate the understanding and correction of this nasal deformity in rhinoplasty.